Provider Demographics
NPI:1740317536
Name:CROSS, MARK DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
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 1:7444 S STIVERS RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-8555
Mailing Address - Country:US
Mailing Address - Phone:937-855-7001
Mailing Address - Fax:
Practice Address - Street 1:1291 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1715
Practice Address - Country:US
Practice Address - Phone:937-855-4704
Practice Address - Fax:937-855-4704
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0175981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice