Healthcare Provider Details

I. General information

NPI: 1952616062
Provider Name (Legal Business Name): TIMOTHY H CROSS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15920 S RANCHO SAHUARITA BLVD SUITE 100
SAHUARITA AZ
85629-8012
US

IV. Provider business mailing address

15920 S RANCHO SAHUARITA BLVD SUITE 100
SAHUARITA AZ
85629-8012
US

V. Phone/Fax

Practice location:
  • Phone: 520-838-0600
  • Fax: 520-838-0865
Mailing address:
  • Phone: 520-838-0600
  • Fax: 520-838-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD 8091
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: