Provider Demographics
NPI:1063871804
Name:HAUER, ROSS ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ANDREW
Last Name:HAUER
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 1:101 E CAMINO REAL APT 1041
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6181
Mailing Address - Country:US
Mailing Address - Phone:954-695-5489
Mailing Address - Fax:
Practice Address - Street 1:1722 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2504
Practice Address - Country:US
Practice Address - Phone:772-337-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN218961223P0300X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice