Provider Demographics
NPI:1275643330
Name:ROSS, ERIC JOEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOEL
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:PROF
Other - First Name:ASSURANCE DENTAL
Other - Middle Name:GROUP,
Other - Last Name:PL.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:526 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428
Mailing Address - Country:US
Mailing Address - Phone:352-795-3939
Mailing Address - Fax:352-795-9223
Practice Address - Street 1:526 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-4002
Practice Address - Country:US
Practice Address - Phone:352-795-3939
Practice Address - Fax:352-795-9223
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist