Provider Demographics
NPI:1881710945
Name:CROSS, JOSHUA RUSSELL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RUSSELL
Last Name:CROSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:163 W VAN ASCHE LOOP
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4974
Mailing Address - Country:US
Mailing Address - Phone:479-966-4004
Mailing Address - Fax:479-935-4004
Practice Address - Street 1:163 W VAN ASCHE LOOP
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4974
Practice Address - Country:US
Practice Address - Phone:479-966-4004
Practice Address - Fax:479-935-4004
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery