Provider Demographics
NPI:1699473041
Name:CROSS, DOMINIC WALTER
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:WALTER
Last Name:CROSS
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 1:4211 CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6878
Mailing Address - Country:US
Mailing Address - Phone:330-592-2813
Mailing Address - Fax:
Practice Address - Street 1:4211 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6878
Practice Address - Country:US
Practice Address - Phone:330-592-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care