Provider Demographics
NPI:1790891190
Name:LAWRENCE J. ROSS, DDS & MARK A. PULLANO, DMD, PC
Entity Type:Organization
Organization Name:LAWRENCE J. ROSS, DDS & MARK A. PULLANO, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-458-8368
Mailing Address - Street 1:190 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2604
Mailing Address - Country:US
Mailing Address - Phone:413-458-8368
Mailing Address - Fax:413-458-0932
Practice Address - Street 1:190 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2604
Practice Address - Country:US
Practice Address - Phone:413-458-8368
Practice Address - Fax:413-458-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX10842OtherBC/BS ID #