Provider Demographics
NPI:1174844252
Name:MAILLOUX-KROSS, BRITTANY ANGEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:ANGEL
Last Name:MAILLOUX-KROSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRITTANY
Other - Middle Name:A
Other - Last Name:MAILLOUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:601 MICHIGAN AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4951
Mailing Address - Country:US
Mailing Address - Phone:616-392-3717
Mailing Address - Fax:616-392-1536
Practice Address - Street 1:601 MICHIGAN AVE
Practice Address - Street 2:STE 106
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4951
Practice Address - Country:US
Practice Address - Phone:616-392-3717
Practice Address - Fax:616-392-1536
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice