Provider Demographics
NPI:1548771660
Name:ROSS, KAREN EVELYN (RDH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:EVELYN
Last Name:ROSS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:EVELYN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2411 WILLIAMS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3268
Mailing Address - Country:US
Mailing Address - Phone:512-864-1445
Mailing Address - Fax:
Practice Address - Street 1:2411 WILLIAMS DR STE 111
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3268
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18012124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist