Provider Demographics
NPI:1619609740
Name:CROSS, BENJAMIN HUNTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HUNTER
Last Name:CROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 13TH ST NE UNIT 2306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5044
Mailing Address - Country:US
Mailing Address - Phone:229-848-1879
Mailing Address - Fax:
Practice Address - Street 1:354 BULLSBORO DR STE 4
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1069
Practice Address - Country:US
Practice Address - Phone:770-683-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist