MEDICARE: ANGELA MARIA ROSS D.D.S.

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	DS000007201	TN

General Provider Information

NPI Number	:	1124004098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIA ROSS D.D.S.

Provider Business Mailing Address
First Line	:	173 BRIAN CIR
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-4342
Country	:	US
Telephone Number	:	615-834-2611
Fax Number	:	615-837-1837

Provider Business Practice Location Address
First Line	:	710 HART LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37216-2627
Country	:	US
Telephone Number	:	615-650-7060
Fax Number	:	615-262-6139

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	09/07/2012

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