Provider Demographics
NPI:1750512927
Name:AUSTIN, ROSS DUANE (DDS)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:DUANE
Last Name:AUSTIN
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 1:6006 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3045
Mailing Address - Country:US
Mailing Address - Phone:509-965-0080
Mailing Address - Fax:509-965-7328
Practice Address - Street 1:1006 S. 64TH AVE., SUITE 130
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-965-0080
Practice Address - Fax:509-965-7328
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60098984122300000X
WA600989841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist