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General NPI Number Information
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NPI Number | 1770102576
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Entity Type | Individual
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Provider Name | CHAD ALAN ROSS
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Gender | Male
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Dates
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Enumeration Date | 04/11/2020
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 61 ERIE PKWY
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City | ERIE
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State | CO
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Zip | 80516-2591
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Country | US
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Telephone | 303-500-3202
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Fax |
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Provider Business Mailing Address
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Address Line | 2308 RANCH DR
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City | WESTMINSTER
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State | CO
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Zip | 80234-2667
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Country | US
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Telephone | 727-631-1225
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN.00205855
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License Number State | CO
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