Provider Demographics
NPI:1184886160
Name:ROSS, HERSCHEL (HERSCHEL ROSS DDS)
Entity type:Individual
Prefix:DR
First Name:HERSCHEL
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:HERSCHEL ROSS DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1999
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-1999
Mailing Address - Country:US
Mailing Address - Phone:970-927-9112
Mailing Address - Fax:970-927-5342
Practice Address - Street 1:234 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8162
Practice Address - Country:US
Practice Address - Phone:970-927-9112
Practice Address - Fax:970-927-5342
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice