Provider Demographics
NPI:1619261658
Name:CROSS, STANLEY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LEE
Last Name:CROSS
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 1:827 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-9240
Mailing Address - Country:US
Mailing Address - Phone:217-253-3254
Mailing Address - Fax:
Practice Address - Street 1:827 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-9240
Practice Address - Country:US
Practice Address - Phone:217-253-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.011256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist