Provider Demographics
NPI:1013117290
Name:ROSS, S BURTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:BURTON
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 1:2122 N CRAYCROFT RD
Mailing Address - Street 2:#106
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2849
Mailing Address - Country:US
Mailing Address - Phone:520-886-3100
Mailing Address - Fax:520-886-4647
Practice Address - Street 1:2122 N CRAYCROFT RD
Practice Address - Street 2:#106
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2849
Practice Address - Country:US
Practice Address - Phone:520-886-3100
Practice Address - Fax:520-886-4647
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist