Provider Demographics
NPI:1881727659
Name:STANGELAND, ROSS MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:MARTIN
Last Name:STANGELAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:358 MARINE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1010
Mailing Address - Country:US
Mailing Address - Phone:650-595-0106
Mailing Address - Fax:650-596-9347
Practice Address - Street 1:358 MARINE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1010
Practice Address - Country:US
Practice Address - Phone:650-595-0106
Practice Address - Fax:650-596-9347
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice