Provider Demographics
NPI:1225245897
Name:ROSS, PATRICIA NIZIOLEK (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NIZIOLEK
Last Name:ROSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11980 SAN VICENTE BLVD
Mailing Address - Street 2:#819
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6606
Mailing Address - Country:US
Mailing Address - Phone:310-207-4200
Mailing Address - Fax:310-979-8900
Practice Address - Street 1:11980 SAN VICENTE BLVD
Practice Address - Street 2:#819
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6606
Practice Address - Country:US
Practice Address - Phone:310-207-4200
Practice Address - Fax:310-979-8900
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist