Healthcare Provider Details

I. General information

NPI: 1306561048
Provider Name (Legal Business Name): JANIKA LEE ROSS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10525 S EASTERN AVE STE 100
HENDERSON NV
89052-3971
US

IV. Provider business mailing address

210 QUEST PARK ST APT 528
HENDERSON NV
89074-1485
US

V. Phone/Fax

Practice location:
  • Phone: 702-508-0906
  • Fax:
Mailing address:
  • Phone: 702-445-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7708
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7708
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: