Healthcare Provider Details

I. General information

NPI: 1194739581
Provider Name (Legal Business Name): ALLAN C ROSS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 S WASHINGTON AVE
SABETHA KS
66534-2625
US

IV. Provider business mailing address

502 S WASHINGTON AVE
SABETHA KS
66534-2625
US

V. Phone/Fax

Practice location:
  • Phone: 785-284-3010
  • Fax: 785-284-3136
Mailing address:
  • Phone: 785-284-3010
  • Fax: 785-284-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6188
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: