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General NPI Number Information
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NPI Number | 1306148291
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Entity Type | Individual
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Provider Name | TRACY ROSS RDH
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Gender | Female
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Dates
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Enumeration Date | 11/26/2010
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Last Update Date | 11/26/2010
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Provider Practice Location Address
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Address Line | 10602 CHAPMAN AVE SUITE 200
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City | GARDEN GROVE
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State | CA
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Zip | 92840-3146
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Country | US
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Telephone | 714-638-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 293 BOWLING GREEN DR
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City | COSTA MESA
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State | CA
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Zip | 92626-6104
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Country | US
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Telephone | 714-549-9942
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 17383
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License Number State | CA
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