Provider Demographics
NPI:1245313600
Name:CROSLAND, JOHN EVERETT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVERETT
Last Name:CROSLAND
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 1:901 N LAFAYETTE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3832
Mailing Address - Country:US
Mailing Address - Phone:704-484-0148
Mailing Address - Fax:704-484-0148
Practice Address - Street 1:901 N LAFAYETTE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3832
Practice Address - Country:US
Practice Address - Phone:704-484-0148
Practice Address - Fax:704-484-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC48911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC91901OtherBLUE CROSS BLUE SHIELD
NCT63848Medicare UPIN
NC91901OtherBLUE CROSS BLUE SHIELD