Healthcare Provider Details

I. General information

NPI: 1841354321
Provider Name (Legal Business Name): DANA MICHELLE ROSS D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E LEE AVE
SAPULPA OK
74066-4215
US

IV. Provider business mailing address

3103 SUMMIT PL
SAND SPRINGS OK
74063-3138
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-7000
  • Fax: 918-224-2464
Mailing address:
  • Phone: 918-241-6415
  • Fax: 918-224-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberOK5700
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: