Provider Demographics
NPI:1609887538
Name:CROSSLAND, KENNETH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:CROSSLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4026
Mailing Address - Country:US
Mailing Address - Phone:806-655-4181
Mailing Address - Fax:806-655-0351
Practice Address - Street 1:2000 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4026
Practice Address - Country:US
Practice Address - Phone:806-655-4181
Practice Address - Fax:806-655-0351
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist