Provider Demographics
NPI:1811989106
Name:CROSS, KEVIN D (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:CROSS
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 1:415 KILLINGWORTH RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4370
Mailing Address - Country:US
Mailing Address - Phone:860-345-4538
Mailing Address - Fax:860-345-4483
Practice Address - Street 1:415 KILLINGWORTH RD
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441-4370
Practice Address - Country:US
Practice Address - Phone:860-345-4538
Practice Address - Fax:860-345-4483
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT74241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice