Provider Demographics
NPI:1407947344
Name:GAYLAN K. ROSS D.M.D., PC
Entity Type:Organization
Organization Name:GAYLAN K. ROSS D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-349-5660
Mailing Address - Street 1:1290 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2340
Mailing Address - Country:US
Mailing Address - Phone:724-349-5660
Mailing Address - Fax:724-349-5661
Practice Address - Street 1:1290 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2340
Practice Address - Country:US
Practice Address - Phone:724-349-5660
Practice Address - Fax:724-349-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018712L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty