Provider Demographics
NPI:1467770693
Name:ROSS, BRADLEY AARON (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:AARON
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 N KENDALL DR
Mailing Address - Street 2:STE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2299
Mailing Address - Country:US
Mailing Address - Phone:305-270-1350
Mailing Address - Fax:
Practice Address - Street 1:8720 N KENDALL DR
Practice Address - Street 2:STE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2299
Practice Address - Country:US
Practice Address - Phone:305-270-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics