Provider Demographics
NPI:1770655623
Name:MOHR, ROSS IAN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:IAN
Last Name:MOHR
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Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:3900 EUBANK BLVD NE
Mailing Address - Street 2:SAN GABRIEL PLAZA, SUITE 7
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3465
Mailing Address - Country:US
Mailing Address - Phone:505-292-1282
Mailing Address - Fax:505-292-1660
Practice Address - Street 1:3900 EUBANK BLVD NE
Practice Address - Street 2:SAN GABRIEL PLAZA, SUITE 7
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3465
Practice Address - Country:US
Practice Address - Phone:505-292-1282
Practice Address - Fax:505-292-1660
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM20411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics