Provider Demographics
NPI:1679862007
Name:COUWENHOVEN, ROSS I (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:I
Last Name:COUWENHOVEN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W. BALTIMORE ST., RM 7205
Mailing Address - Street 2:UNIVERSITY OF MARYLAND DENTAL SCHOOL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-706-7629
Mailing Address - Fax:
Practice Address - Street 1:650 W. BALTIMORE ST., RM 7205
Practice Address - Street 2:UNIVERSITY OF MARYLAND DENTAL SCHOOL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-706-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL5971223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology