Provider Demographics
NPI:1285857201
Name:ROSS, JOHN BENNETT V (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENNETT
Last Name:ROSS
Suffix:V
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 SAM PAGE RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7555
Mailing Address - Country:US
Mailing Address - Phone:903-663-2345
Mailing Address - Fax:
Practice Address - Street 1:815 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5442
Practice Address - Country:US
Practice Address - Phone:903-757-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics