Provider Demographics
NPI:1972622041
Name:ROSS, RYAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
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 1:11545 LOS OSOS VALLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-6470
Mailing Address - Country:US
Mailing Address - Phone:805-541-5800
Mailing Address - Fax:805-541-2083
Practice Address - Street 1:11545 LOS OSOS VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6470
Practice Address - Country:US
Practice Address - Phone:805-541-5800
Practice Address - Fax:805-541-2083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice