Ross H Fishman, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN16716 Issued in FL

Practice address

425 W Town PL Ste 106
St Augustine, FL 32092-3662

Phone

(904) 940-7990

NPI assigned

Feb 21, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Village Dentist

  • General Practice Dentistry
  • St Augustine, FL
  • NPI 1205132503
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300320000000",
    "number": "1366417594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W TOWN PL STE 106",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923662",
            "telephone_number": "904-940-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W TOWN PL STE 106",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923662",
            "telephone_number": "904-940-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHMAN",
        "first_name": "ROSS",
        "middle_name": "H",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2011-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075770500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• First Coast Wound Care LLC
• First Step Counseling Center
• Angela Diane Fitts, LCSW
• Joseph Michael Fitzgerald, FNP
• April Fitzsimmons, L.AC
• FL Southern Dental PA
• Flagler Family Medicine P a

• Dentist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.