Provider Demographics
NPI:1063566172
Name:RONALD F ROSSER DDS PC
Entity type:Organization
Organization Name:RONALD F ROSSER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-453-3159
Mailing Address - Street 1:690 SW HIGGINS AVE
Mailing Address - Street 2:STE H
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1433
Mailing Address - Country:US
Mailing Address - Phone:406-543-3159
Mailing Address - Fax:406-543-3150
Practice Address - Street 1:690 SW HIGGINS AVE
Practice Address - Street 2:STE H
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1433
Practice Address - Country:US
Practice Address - Phone:406-543-3159
Practice Address - Fax:406-543-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0113713Medicaid
MT5513015OtherCHIP ACS