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General NPI Number Information
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NPI Number | 1275643330
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Entity Type | Individual
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Provider Name | ERIC JOEL ROSS DMD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 526 NW 1ST AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-4002
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Country | US
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Telephone | 352-795-3939
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Fax | 352-795-9223
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Provider Business Mailing Address
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Address Line | 526 NW 1ST AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428
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Country | US
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Telephone | 352-795-3939
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Fax | 352-795-9223
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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 | DN 12396
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License Number State | FL
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