Provider Demographics
NPI:1982102588
Name:ROSS DENTAL OF TEXAS PC
Entity Type:Organization
Organization Name:ROSS DENTAL OF TEXAS PC
Other - Org Name:ROSS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIREGUNTANURU ANKALAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-259-0638
Mailing Address - Street 1:8629 DUKE TER APT 7102
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-1679
Mailing Address - Country:US
Mailing Address - Phone:617-671-8302
Mailing Address - Fax:
Practice Address - Street 1:7260 BLUE MOUND RD STE 148
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-8830
Practice Address - Country:US
Practice Address - Phone:817-259-0638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31583261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental