Provider Demographics
NPI:1700035524
Name:ROSS, KENNETH E (DMD, MSD, PA)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD, MSD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11239 RIVERS BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-1847
Mailing Address - Country:US
Mailing Address - Phone:561-212-1166
Mailing Address - Fax:
Practice Address - Street 1:2820 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6220
Practice Address - Country:US
Practice Address - Phone:941-926-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN134271223P0300X
FLDN00134271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics