Provider Demographics
NPI:1851458376
Name:ROSS, JAMES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:ROSS
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 1:901 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5146
Mailing Address - Country:US
Mailing Address - Phone:704-776-4157
Mailing Address - Fax:704-776-4198
Practice Address - Street 1:901 OAK FOREST DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5146
Practice Address - Country:US
Practice Address - Phone:704-776-4157
Practice Address - Fax:704-776-4198
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910303Medicaid