Provider Demographics
NPI:1659891547
Name:ROSS, ENRICO PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:ENRICO
Middle Name:PAUL
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 1:125 NORTHPORT AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6002
Mailing Address - Country:US
Mailing Address - Phone:207-338-9307
Mailing Address - Fax:
Practice Address - Street 1:125 NORTHPORT AVE STE 107
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6002
Practice Address - Country:US
Practice Address - Phone:207-338-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist