Healthcare Provider Details

I. General information

NPI: 1376688473
Provider Name (Legal Business Name): DR KENNETH E ROSS, DMD, MSD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 36TH ST STE. 103
LIGHTHOUSE POINT FL
33064-7577
US

IV. Provider business mailing address

2211 NE 36TH ST STE. 103
LIGHTHOUSE POINT FL
33064-7577
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-2277
  • Fax: 954-785-5034
Mailing address:
  • Phone: 954-941-2277
  • Fax: 954-785-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN 0013427
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KENNETH E. ROSS
Title or Position: PERIODONTIST
Credential: DMD
Phone: 954-941-2277