Provider Demographics
NPI:1710621305
Name:ROSS DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:ROSS DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JATERRA
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-404-7029
Mailing Address - Street 1:608 MEANDERING TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-4835
Mailing Address - Country:US
Mailing Address - Phone:847-404-7029
Mailing Address - Fax:
Practice Address - Street 1:2111 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7240
Practice Address - Country:US
Practice Address - Phone:214-225-2358
Practice Address - Fax:469-881-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental