Provider Demographics
NPI:1245280627
Name:ROSS, DENNIS CHARLES (CRNA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:CHARLES
Last Name:ROSS
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:2600 SIXTH STREET SW
Mailing Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORP
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-363-7462
Mailing Address - Fax:330-363-7679
Practice Address - Street 1:2600 SIXTH STREET SW
Practice Address - Street 2:OHIO HOSPITAL BASED PHYSICIAN CORP
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-363-7462
Practice Address - Fax:330-363-7679
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN168079367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0793253Medicaid
OHR08200883Medicare ID - Type Unspecified