Jason Philip Ross, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10994 Issued in MN

Practice address

4706 Banning Ave
White Bear Lake, MN 55110-3216

Phone

(651) 429-3348

Fax

(651) 429-3945

NPI assigned

Apr 8, 2008

Last updated

Apr 8, 2008By the provider in NPPES

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Lakeshore Family Dentistry PA

  • General Practice Dentistry
  • White Bear Lake, MN
  • NPI 1669585154
  NPD (past)

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207612800000",
    "number": "1548433808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4706 BANNING AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103216",
            "telephone_number": "651-429-3348",
            "fax_number": "651-429-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4706 BANNING AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103216",
            "telephone_number": "651-429-3348",
            "fax_number": "651-429-3945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "JASON",
        "middle_name": "PHILIP",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-08",
        "last_updated": "2008-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Drug Corp (Merwin Home Medical)
• Roger G. Ettel D.D.S. & Associates, PA
• Jo Lynn Rohady, MS RN CS
• Kessiah Serena Rosario
• Rosewood Family Therapy, Inc.
• Lauren Marie Rudie
• Wendy Noel Rufledt, OTR/L
• Olaf Jonathan Rustad, MD
• Ruth A Rustad, MD
• Jessica M Rutten, DPT

• General Practice Dentistry in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.