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General NPI Number Information
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NPI Number | 1790015618
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Entity Type | Individual
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Provider Name | SASHA ROSS D.M.D., M.S.
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Gender | Female
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 3609 PARK EAST DR STE 411
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City | BEACHWOOD
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State | OH
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Zip | 44122-4309
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Country | US
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Telephone | 216-464-8985
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Fax |
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Provider Business Mailing Address
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Address Line | 5890 ASHCROFT DR
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-3135
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Country | US
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Telephone | 216-338-7078
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30-023456
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License Number State | OH
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