Provider Demographics
NPI:1790860930
Name:ANDERSON, ROSS WYATT (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:WYATT
Last Name:ANDERSON
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 1:1106 NORTH MECHANIC STREET
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437
Mailing Address - Country:US
Mailing Address - Phone:975-543-4291
Mailing Address - Fax:979-543-8482
Practice Address - Street 1:1106 NORTH MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437
Practice Address - Country:US
Practice Address - Phone:975-543-4291
Practice Address - Fax:979-543-8482
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist