Provider Demographics
NPI:1124750989
Name:CROSS, VANESSA CORINA OLIVIA (DDS)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:CORINA OLIVIA
Last Name:CROSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BOONE HALL WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6034
Mailing Address - Country:US
Mailing Address - Phone:772-359-6727
Mailing Address - Fax:
Practice Address - Street 1:2935 BREEZEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5498
Practice Address - Country:US
Practice Address - Phone:910-323-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist