Provider Demographics
NPI:1205982055
Name:ROST, ERWIN ROSS (DDS)
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:ROSS
Last Name:ROST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W 34TH ST
Mailing Address - Street 2:#202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1923
Mailing Address - Country:US
Mailing Address - Phone:512-454-5276
Mailing Address - Fax:
Practice Address - Street 1:1305 W 34TH ST
Practice Address - Street 2:#202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1922
Practice Address - Country:US
Practice Address - Phone:512-454-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice