Provider Demographics
NPI:1275387433
Name:CROSS, KARIN MAVIS (RDHAP)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:MAVIS
Last Name:CROSS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 CALLE LA PALMERA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2722
Mailing Address - Country:US
Mailing Address - Phone:805-607-0992
Mailing Address - Fax:
Practice Address - Street 1:855 CALLE LA PALMERA
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2722
Practice Address - Country:US
Practice Address - Phone:805-607-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1010124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist