Provider Demographics
NPI:1508906017
Name:ROSS, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E DRINKER ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2589
Mailing Address - Country:US
Mailing Address - Phone:570-348-0464
Mailing Address - Fax:570-343-7049
Practice Address - Street 1:217 E DRINKER ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2589
Practice Address - Country:US
Practice Address - Phone:570-348-0464
Practice Address - Fax:570-343-7049
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA393311OtherNVA PROVIDER NUMBER
PARO200383OtherBLUE SHIELD PROVIDER #
PA393311OtherNVA PROVIDER NUMBER