Provider Demographics
NPI:1518040518
Name:ROSS, LORING LEE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LORING
Middle Name:LEE
Last Name:ROSS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 CADUCEUS DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-2902
Mailing Address - Country:US
Mailing Address - Phone:843-293-3522
Mailing Address - Fax:843-293-0973
Practice Address - Street 1:3508 CADUCEUS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-2902
Practice Address - Country:US
Practice Address - Phone:843-293-3522
Practice Address - Fax:843-293-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2597315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2597315OtherSC STATE LICENSE #