Provider Demographics
NPI:1346465275
Name:GERALD VINCY CROSS, D.D.S., MBA, INC.
Entity Type:Organization
Organization Name:GERALD VINCY CROSS, D.D.S., MBA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:VINCY
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-226-6092
Mailing Address - Street 1:800 12TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5708
Mailing Address - Country:US
Mailing Address - Phone:580-226-6092
Mailing Address - Fax:580-226-8791
Practice Address - Street 1:800 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5708
Practice Address - Country:US
Practice Address - Phone:580-226-6092
Practice Address - Fax:580-226-8791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty