Provider Demographics
NPI:1437645918
Name:DAVID R. ROSS DDS, PC
Entity Type:Organization
Organization Name:DAVID R. ROSS DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:717-637-4131
Mailing Address - Street 1:135 E ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1813
Mailing Address - Country:US
Mailing Address - Phone:717-637-4131
Mailing Address - Fax:717-637-4453
Practice Address - Street 1:135 E ELM AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1813
Practice Address - Country:US
Practice Address - Phone:717-637-4131
Practice Address - Fax:717-637-4453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID R. ROSS DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-08
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1437645918Medicaid