Provider Demographics
NPI:1639222508
Name:ENFINGER, ROSS TANNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:TANNER
Last Name:ENFINGER
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 1:7452 HERRICKS LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1089
Mailing Address - Country:US
Mailing Address - Phone:407-579-1500
Mailing Address - Fax:
Practice Address - Street 1:6001 VINELAND RD
Practice Address - Street 2:SUITE 119
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-352-6001
Practice Address - Fax:407-351-2864
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice