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General NPI Number Information
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NPI Number | 1023407814
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Entity Type | Individual
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Provider Name | MICHAEL ROSS DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 3302 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75246-2013
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Country | US
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Telephone | 972-345-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 9181 TOWN SQUARE BLVD APT 2514
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City | AMARILLO
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State | TX
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Zip | 79119-1238
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Country | US
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Telephone | 972-345-3818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30187
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30187
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License Number State | TX
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