MEDICARE: DR. LORING LEE ROSS D.D.S., M.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	122300000X	Dentist	2597315	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2597315	OTHER	SC	SC STATE LICENSE #

General Provider Information

NPI Number	:	1518040518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORING LEE ROSS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	3508 CADUCEUS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-2902
Country	:	US
Telephone Number	:	843-293-3522
Fax Number	:	843-293-0973

Provider Business Practice Location Address
First Line	:	3508 CADUCEUS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-2902
Country	:	US
Telephone Number	:	843-293-3522
Fax Number	:	843-293-0973

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LORING LEE ROSS D.D.S., M.S.” Practice Location

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