MEDICARE: DR. RHODA S ROSS DDS

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	1223E0200X	Endodontics	DG33361	CA

General Provider Information

NPI Number	:	1881860120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RHODA S ROSS DDS

Provider Business Mailing Address
First Line	:	1711 VIA EL PRADO
Second Line	:	STE 303
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5714
Country	:	US
Telephone Number	:	310-792-4833
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 VIA EL PRADO
Second Line	:	STE 303
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5714
Country	:	US
Telephone Number	:	310-792-4833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	01/05/2010

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