Provider Demographics
NPI:1528199122
Name:MONFORT, DAVID ROSS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROSS
Last Name:MONFORT
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:250 W BRIDGE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2123
Mailing Address - Country:US
Mailing Address - Phone:614-889-7613
Mailing Address - Fax:614-889-6317
Practice Address - Street 1:250 W BRIDGE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2123
Practice Address - Country:US
Practice Address - Phone:614-889-7613
Practice Address - Fax:614-889-6317
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH145241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics