Provider Demographics
NPI:1942521091
Name:KROSS, KEVIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:KROSS
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 1:4868 LAKE MICHIGAN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8434
Mailing Address - Country:US
Mailing Address - Phone:616-895-7400
Mailing Address - Fax:616-895-4375
Practice Address - Street 1:4868 LAKE MICHIGAN DR
Practice Address - Street 2:SUITE A
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8434
Practice Address - Country:US
Practice Address - Phone:616-895-7400
Practice Address - Fax:616-895-4375
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice