Provider Demographics
NPI:1740568302
Name:MADDOX, ROSS B (DDS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:B
Last Name:MADDOX
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 1:9000 ANDERSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-4501
Mailing Address - Country:US
Mailing Address - Phone:512-331-9088
Mailing Address - Fax:512-918-9017
Practice Address - Street 1:9000 ANDERSON MILL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-4501
Practice Address - Country:US
Practice Address - Phone:512-331-9088
Practice Address - Fax:512-918-9017
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist