Provider Demographics
NPI:1194739581
Name:ROSS, ALLAN C (DDS)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:C
Last Name:ROSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-2625
Mailing Address - Country:US
Mailing Address - Phone:785-284-3010
Mailing Address - Fax:785-284-3136
Practice Address - Street 1:502 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534-2625
Practice Address - Country:US
Practice Address - Phone:785-284-3010
Practice Address - Fax:785-284-3136
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS008805OtherBCBS