Provider Demographics
NPI:1568434934
Name:ROSS, MARK COLLINS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:COLLINS
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 ROLLING ACRES ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-259-8284
Mailing Address - Fax:352-259-8217
Practice Address - Street 1:922 ROLLING ACRES ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-259-8284
Practice Address - Fax:352-259-8217
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist