Healthcare Provider Details

I. General information

NPI: 1528853801
Provider Name (Legal Business Name): DANA ROSS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

IV. Provider business mailing address

PO BOX 12798
OKLAHOMA CITY OK
73157
US

V. Phone/Fax

Practice location:
  • Phone: 405-858-2700
  • Fax:
Mailing address:
  • Phone: 405-858-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: