Provider Demographics
NPI:1164511788
Name:CROSS, JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 WASHINGTON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-2008
Mailing Address - Country:US
Mailing Address - Phone:732-356-5050
Mailing Address - Fax:732-356-8691
Practice Address - Street 1:1794 WASHINGTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2008
Practice Address - Country:US
Practice Address - Phone:732-356-5050
Practice Address - Fax:732-356-8691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016634001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics