MEDICARE: ROSS DENTAL CORPORATION

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	122300000X	Dentist	34414	CA

General Provider Information

NPI Number	:	1376914424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	6902 NAVAJO RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1563
Country	:	US
Telephone Number	:	619-582-9700
Fax Number	:	619-583-6932

Provider Business Practice Location Address
First Line	:	6902 NAVAJO RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1563
Country	:	US
Telephone Number	:	619-582-9700
Fax Number	:	619-583-6932

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. BRADLEY ROSS
Credential	:	DDS
Telephone Number	:	619-582-9700

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/15/2015

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Directions to “ROSS DENTAL CORPORATION ” Practice Location

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