Provider Demographics
NPI:1841502515
Name:RICKOFF, ROSS ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ANDREW
Last Name:RICKOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9590 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4443
Mailing Address - Country:US
Mailing Address - Phone:770-232-5112
Mailing Address - Fax:770-232-5115
Practice Address - Street 1:9590 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE G
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4443
Practice Address - Country:US
Practice Address - Phone:770-232-5112
Practice Address - Fax:770-232-5115
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4713122300000X
GADN0145411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist