Basic Information
| Provider Information | |||||||||
| NPI: | 1548771660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | EVELYN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RDH | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROSS | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | EVELYN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1295 COUNTY ROAD 3068 | ||||||||
| Address2: | |||||||||
| City: | LAMPASAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765503880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2543681319 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2411 WILLIAMS DR STE 111 | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786283268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778005722 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2017 | ||||||||
| LastUpdateDate: | 10/16/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 18012 | TX | Y | Dental Providers | Dental Hygienist |
No ID Information.