Provider Demographics
NPI:1932377595
Name:ROSS, JOSEPH MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARC
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 1:18 S SPRING ST
Mailing Address - Street 2:PO BOX 599
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1825
Mailing Address - Country:US
Mailing Address - Phone:931-836-2416
Mailing Address - Fax:931-836-3146
Practice Address - Street 1:18 S SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1825
Practice Address - Country:US
Practice Address - Phone:931-836-2416
Practice Address - Fax:931-836-3146
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS40151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice