Provider Demographics
NPI:1255178182
Name:ROSS, FARRAH (DMD)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 CLARKS POND PKWY APT 204
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-7917
Mailing Address - Country:US
Mailing Address - Phone:289-834-4667
Mailing Address - Fax:
Practice Address - Street 1:44 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:FRYEBURG
Practice Address - State:ME
Practice Address - Zip Code:04037-1206
Practice Address - Country:US
Practice Address - Phone:207-935-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN5144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist