Provider Demographics
NPI:1942237375
Name:CROSS, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
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 1:1017 CHEESEFACTORY RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7177
Mailing Address - Country:US
Mailing Address - Phone:802-985-8170
Mailing Address - Fax:
Practice Address - Street 1:97 BLAKELY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4008
Practice Address - Country:US
Practice Address - Phone:802-862-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT839OtherDENTAL LICENSE NUMBER