Provider Demographics
NPI:1063411585
Name:ROSS, DAVID MATTHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5205
Mailing Address - Country:US
Mailing Address - Phone:503-363-6892
Mailing Address - Fax:503-378-1487
Practice Address - Street 1:1925 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5205
Practice Address - Country:US
Practice Address - Phone:503-363-6892
Practice Address - Fax:503-378-1487
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice