Provider Demographics
NPI:1710073374
Name:ROSS, ANDREW DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:ROSS
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 1:745 N FOWLER AVE
Mailing Address - Street 2:APT 102
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6694
Mailing Address - Country:US
Mailing Address - Phone:559-323-7141
Mailing Address - Fax:
Practice Address - Street 1:745 N FOWLER AVE
Practice Address - Street 2:APT 102
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6694
Practice Address - Country:US
Practice Address - Phone:559-323-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist