Provider Demographics
NPI:1710991948
Name:CROSS, JOHN J (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
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 1:20271 SW ACACIA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-261-1123
Mailing Address - Fax:949-791-0174
Practice Address - Street 1:20271 SW ACACIA ST
Practice Address - Street 2:STE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-261-1123
Practice Address - Fax:949-791-0174
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice