Provider Demographics
NPI:1871887984
Name:ROSS, ALISON HOGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:HOGAN
Last Name:ROSS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 W OXFORD LOOP
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5726
Mailing Address - Country:US
Mailing Address - Phone:662-234-2722
Mailing Address - Fax:662-234-2727
Practice Address - Street 1:2710 W OXFORD LOOP
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5726
Practice Address - Country:US
Practice Address - Phone:662-234-2722
Practice Address - Fax:662-234-2727
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3583-111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07723291Medicaid