MEDICARE: DR. DONALD ROSS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1003989740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD ROSS D.M.D.

Provider Business Mailing Address
First Line	:	3600 WINTERGREEN TER
Second Line	:
City	:	ALGONQUIN
State	:	IL
Zip	:	60102-6367
Country	:	US
Telephone Number	:	847-426-8799
Fax Number	:	847-426-9415

Provider Business Practice Location Address
First Line	:	5000 SPRING HILL MALL
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1267
Country	:	US
Telephone Number	:	800-426-8799
Fax Number	:	847-426-9415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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