Individual
GRANT ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1100 RUCKER BLVD STE A1, ENTERPRISE, AL 36330-3623
(334) 347-5550
(334) 347-5551
Mailing address
478 MAYBERRY WAY, NEW BROCKTON, AL 36351-5527
(601) 503-3598
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D.0006775-C1
AL
122300000X
Dentist
DN24882
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/26/2019
Last updated
06/16/2020
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