Individual
DR. JATERRA DOMINIQUE ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
12300 DORSETT RD, MARYLAND HEIGHTS, MO 63043-3906
(314) 254-4000
(314) 732-1826
Mailing address
7407 CEDAR DR, GODFREY, IL 62035-2710
(847) 404-7029
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2019021855
MO
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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