Provider Demographics
NPI:1881014512
Name:ROSS, AMOS BEN
Entity type:Individual
Prefix:DR
First Name:AMOS
Middle Name:BEN
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 BARWICK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FT. WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-292-2555
Mailing Address - Fax:817-370-0181
Practice Address - Street 1:4760 BARWICK, DR,
Practice Address - Street 2:SUITE B
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-292-2555
Practice Address - Fax:817-370-0181
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice