Healthcare Provider Details

I. General information

NPI: 1437645918
Provider Name (Legal Business Name): DAVID R. ROSS DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E ELM AVE
HANOVER PA
17331-1813
US

IV. Provider business mailing address

135 E ELM AVE
HANOVER PA
17331-1813
US

V. Phone/Fax

Practice location:
  • Phone: 717-637-4131
  • Fax: 717-637-4453
Mailing address:
  • Phone: 717-637-4131
  • Fax: 717-637-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS036159
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID ROBERT ROSS
Title or Position: ORTHODONTIST
Credential: DDS, MS
Phone: 717-637-4131