Provider Demographics
NPI:1194774422
Name:ROSS, LISA KAY (RDH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:ROSS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 COLUMBINE CIR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-9084
Mailing Address - Country:US
Mailing Address - Phone:785-820-0857
Mailing Address - Fax:
Practice Address - Street 1:223 N DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-3215
Practice Address - Country:US
Practice Address - Phone:785-472-3803
Practice Address - Fax:785-472-3620
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2364124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist