Provider Demographics
NPI:1710984836
Name:ROSSO-TRIDAS, INGRID M (DMD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:M
Last Name:ROSSO-TRIDAS
Suffix:
Gender:F
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:PO BOX 801062
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1062
Mailing Address - Country:US
Mailing Address - Phone:787-837-4544
Mailing Address - Fax:787-837-3851
Practice Address - Street 1:54 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1608
Practice Address - Country:US
Practice Address - Phone:787-837-4544
Practice Address - Fax:787-837-3851
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice