Provider Demographics
NPI:1700939055
Name:ROSS, DANIEL J (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:ROSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E WILSON STREET
Mailing Address - Street 2:PO BOX 717
Mailing Address - City:NORWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55368-0717
Mailing Address - Country:US
Mailing Address - Phone:952-467-3518
Mailing Address - Fax:952-467-3528
Practice Address - Street 1:222 E. WILSON STREET
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MN
Practice Address - Zip Code:55368-0717
Practice Address - Country:US
Practice Address - Phone:952-467-3518
Practice Address - Fax:952-467-3528
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist