Provider Demographics
NPI:1841354321
Name:ROSS, DANA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:MICHELLE
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 1:3103 SUMMIT PL
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3138
Mailing Address - Country:US
Mailing Address - Phone:918-241-6415
Mailing Address - Fax:918-224-2464
Practice Address - Street 1:101 E LEE AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4215
Practice Address - Country:US
Practice Address - Phone:918-224-7000
Practice Address - Fax:918-224-2464
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK5700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist