Provider Demographics
NPI:1396789277
Name:ROSS, BRUCE ALAN (DMD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2010
Mailing Address - Country:US
Mailing Address - Phone:207-364-2280
Mailing Address - Fax:207-364-4716
Practice Address - Street 1:10 KNOX ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2010
Practice Address - Country:US
Practice Address - Phone:207-364-2280
Practice Address - Fax:207-364-4716
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist