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General NPI Number Information
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NPI Number | 1336441591
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Entity Type | Organization
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Legal Business Name | ROSS FAMILY DENTAL CLINIC
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Dates
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Enumeration Date | 11/21/2010
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Last Update Date | 11/21/2010
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Provider Practice Location Address
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Address Line | 127 HERITAGE DR
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City | OXFORD
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State | MS
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Zip | 38655-5458
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Country | US
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Telephone | 662-234-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 127 HERITAGE DR
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City | OXFORD
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State | MS
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Zip | 38655-5458
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Country | US
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Telephone | 662-234-2722
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Fax |
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | DR. ANDREW S ROSS
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Credential | D.M.D.
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Telephone | 662-234-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 349309
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License Number State | MS
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