Provider Demographics
NPI:1639180565
Name:EPSTEIN, ROSS (DDS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 KILN CREEK PKWY STE J
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9700
Mailing Address - Country:US
Mailing Address - Phone:757-875-2273
Mailing Address - Fax:757-875-0763
Practice Address - Street 1:1405 KILN CREEK PKWY STE J
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9700
Practice Address - Country:US
Practice Address - Phone:757-875-2273
Practice Address - Fax:757-875-0763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010076921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA760169OtherUNITED CONCORDIA PROV. ID
VA093424OtherBCBS PROVIDER ID #