Provider Demographics
NPI:1689788465
Name:ROSS, MELINDA ANN (DDS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:ROSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 STUTZ DR
Mailing Address - Street 2:#2
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9144
Mailing Address - Country:US
Mailing Address - Phone:330-702-8500
Mailing Address - Fax:330-702-8249
Practice Address - Street 1:3665 STUTZ DR
Practice Address - Street 2:#2
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9144
Practice Address - Country:US
Practice Address - Phone:330-702-8500
Practice Address - Fax:330-702-8249
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2383826Medicaid