MEDICARE: DR. ROSS ANDREW HAUER DMD

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	1223P0300X	Periodontics	DN21896	FL
2	1223G0001X	General Practice Dentistry	DN21896	FL

General Provider Information

NPI Number	:	1063871804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS ANDREW HAUER DMD

Provider Business Mailing Address
First Line	:	101 E CAMINO REAL APT 1041
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-6181
Country	:	US
Telephone Number	:	954-695-5489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 SW SAINT LUCIE WEST BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2504
Country	:	US
Telephone Number	:	772-337-8600
Fax Number	:

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

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	06/02/2021

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