Provider Demographics
NPI:1467456491
Name:GROSS, RONALD DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DENNIS
Last Name:GROSS
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 1:13975 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4500
Mailing Address - Country:US
Mailing Address - Phone:636-391-9904
Mailing Address - Fax:636-391-9389
Practice Address - Street 1:13975 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4500
Practice Address - Country:US
Practice Address - Phone:636-391-9904
Practice Address - Fax:636-391-9389
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0121351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice