Provider Demographics
NPI:1881669653
Name:ROSS, WILLIAM RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
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 1:3620 SCROGGINS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2579
Mailing Address - Country:US
Mailing Address - Phone:254-799-5746
Mailing Address - Fax:254-799-4115
Practice Address - Street 1:3620 SCROGGINS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2579
Practice Address - Country:US
Practice Address - Phone:254-799-5746
Practice Address - Fax:254-799-4115
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice