Taylor Randolph Ross

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

00202115 Issued in CO

Practice address

120 S Stardust Dr
Pueblo West, CO 81007-1631

Phone

(719) 547-4474

NPI assigned

Apr 9, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Pueblo West Dental, Prof.LLC

  dba Pueblo West Neighborhood Dental and Implants

  • Dental Clinic/Center
  • Pueblo West, CO
  • NPI 1891456711
  NPD Authorized official
• Pueblo West Neighborhood Dental

  dba Pueblo West Dental Care

  • Dental Clinic/Center
  • Pueblo West, CO
  • NPI 1073039756
  NPD Authorized official

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1528401635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13006 E 17TH PLACE",
            "address_2": "UNIVERSITY OF COLORADO SCHOOL OF DENTAL MEDICINE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452581",
            "telephone_number": "303-724-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S STARDUST DR",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810071631",
            "telephone_number": "719-547-4474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13006 E 17th Place",
            "address_2": "University of Colorado School of Dental Medicine",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452581",
            "country_code": "US",
            "telephone_number": "303-724-6496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSS",
        "first_name": "TAYLOR",
        "middle_name": "RANDOLPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00202115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nicole Ann Rubalcaba-Lopez, PHARM.D.
• Safeway Inc (Safeway Pharmacy #1760)
• Valerie L Saisi
• Kathleen Kyffin Schleifer, MHS, OTR
• David Anthony Scola, M.D.

• General Practice Dentistry in Pueblo West, CO
• Providers in Pueblo West, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.