Provider Demographics
NPI:1104923085
Name:ROSS, KERRY L (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3600
Mailing Address - Country:US
Mailing Address - Phone:505-293-7441
Mailing Address - Fax:505-332-4726
Practice Address - Street 1:10330 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3600
Practice Address - Country:US
Practice Address - Phone:505-293-7441
Practice Address - Fax:505-332-4726
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist