Provider Demographics
NPI:1669642336
Name:ROSS, JONATHAN HAROLD (DDS,MHS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HAROLD
Last Name:ROSS
Suffix:
Gender:M
Credentials:DDS,MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 LANDERBROOK DR
Mailing Address - Street 2:STE. 221
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6532
Mailing Address - Country:US
Mailing Address - Phone:440-461-6008
Mailing Address - Fax:440-461-9282
Practice Address - Street 1:5825 LANDERBROOK DR
Practice Address - Street 2:STE. 221
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6532
Practice Address - Country:US
Practice Address - Phone:440-461-6008
Practice Address - Fax:440-461-9282
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44081223G0001X, 1223P0300X
OH30023878122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist