Provider Demographics
NPI:1326665050
Name:CROSS, RACHAEL NICOLE (DMD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NICOLE
Last Name:CROSS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 BRADLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3078
Mailing Address - Country:US
Mailing Address - Phone:706-322-8988
Mailing Address - Fax:706-327-2907
Practice Address - Street 1:6214 BRADLEY PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3078
Practice Address - Country:US
Practice Address - Phone:706-322-8988
Practice Address - Fax:706-327-2907
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0160471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice