Provider Demographics
NPI:1972642759
Name:AJEMIAN, ROSS (DDS)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:AJEMIAN
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 1:110 LONG POND ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-830-0330
Mailing Address - Fax:508-830-3355
Practice Address - Street 1:110 LONG POND ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-830-0330
Practice Address - Fax:508-830-3355
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14348AJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14348AJOtherLIC NO
MA14348OtherDELTA DENTAL
MA01834OtherAETNA US HEALTH
MAX05260OtherBLUE CROSS BLUE SHIELD
MA14348OtherDELTA CARE