Provider Demographics
NPI:1396874509
Name:DRANGSHOLT, ROSS JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JAMES
Last Name:DRANGSHOLT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:9618 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2799
Mailing Address - Country:US
Mailing Address - Phone:253-512-0265
Mailing Address - Fax:253-588-1463
Practice Address - Street 1:9618 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2799
Practice Address - Country:US
Practice Address - Phone:253-512-0265
Practice Address - Fax:253-588-1463
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE68511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6023529231Medicare UPIN