Provider Demographics
NPI:1891011748
Name:ANDERSON, ROSS ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALLEN
Last Name:ANDERSON
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 1:1225 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2402
Mailing Address - Country:US
Mailing Address - Phone:218-728-6445
Mailing Address - Fax:
Practice Address - Street 1:1225 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2402
Practice Address - Country:US
Practice Address - Phone:218-728-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-18
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127911223G0001X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No282N00000XHospitalsGeneral Acute Care Hospital