Provider Demographics
NPI:1538335278
Name:CROSS, PATRICK C
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:C
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 1:5915 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1626
Mailing Address - Country:US
Mailing Address - Phone:773-685-7121
Mailing Address - Fax:773-685-7143
Practice Address - Street 1:5915 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1626
Practice Address - Country:US
Practice Address - Phone:773-685-7121
Practice Address - Fax:773-685-7143
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist