MEDICARE: ROSS PERIODONTICS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1841145240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS PERIODONTICS P.A.

Provider Business Mailing Address
First Line	:	8720 N KENDALL DR STE 103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2208
Country	:	US
Telephone Number	:	305-930-8827
Fax Number	:	305-274-9876

Provider Business Practice Location Address
First Line	:	8720 N KENDALL DR STE 103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2208
Country	:	US
Telephone Number	:	305-930-8827
Fax Number	:	305-274-9876

Authorized Official
Title or Position	:	CREDENTIAL MANAGER
Name	:	JENNIFER HERITAGE
Credential	:
Telephone Number	:	402-805-4516

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ROSS PERIODONTICS P.A. ” Practice Location

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