Active NPI
Jason Ross, DDS
- General Practice Dentistry
- Madison, MS
National Provider Identifier
1093409153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4368-23
- Practice address
- 105 Broadmoor Dr
Madison, MS 39110-6651 - Phone
- (601) 856-5227
- NPI assigned
- Jun 2, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4368-23 | MS | Primary |
Addresses
Primary practice location
105 Broadmoor Dr
Madison, MS 39110-6651
Mailing address
200 Bordeaux Dr
Clinton, MS 39056-5749
Phone (901) 277-0260
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4368-23 | MS | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685664000000",
"number": "1093409153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 BORDEAUX DR",
"city": "CLINTON",
"state": "MS",
"postal_code": "390565749",
"telephone_number": "901-277-0260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 BROADMOOR DR",
"city": "MADISON",
"state": "MS",
"postal_code": "391106651",
"telephone_number": "601-856-5227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSS",
"first_name": "JASON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-02",
"last_updated": "2023-06-02",
"certification_date": "2023-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MS",
"license": "4368-23",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.