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General NPI Number Information
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NPI Number | 1184043226
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Entity Type | Individual
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Provider Name | GABRIEL ROSS DMD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 2001 2ND AVE STE 102
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City | SUMMERVILLE
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State | SC
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Zip | 29486-7887
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Country | US
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Telephone | 843-876-8815
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Fax | 843-876-8783
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Provider Business Mailing Address
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Address Line | 2001 2ND AVE STE 102
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City | SUMMERVILLE
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State | SC
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Zip | 29486-7887
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Country | US
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Telephone | 843-900-4490
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Fax | 843-501-9450
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8574
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8574
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License Number State | SC
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