Provider Demographics
NPI:1346467131
Name:ROSS, GRAYSON SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:SCOTT
Last Name:ROSS
Suffix:
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 1:78519 HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134
Mailing Address - Country:US
Mailing Address - Phone:901-371-0609
Mailing Address - Fax:901-371-0284
Practice Address - Street 1:78519 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-371-0609
Practice Address - Fax:901-371-0284
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice