Healthcare Provider Details

I. General information

NPI: 1811699671
Provider Name (Legal Business Name): CROSSING DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HOLIDAY RD
MATTOON IL
61938-4668
US

IV. Provider business mailing address

117 HOLIDAY RD
MATTOON IL
61938-4668
US

V. Phone/Fax

Practice location:
  • Phone: 217-235-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: YUDONG XU
Title or Position: CEO
Credential: DMD
Phone: 217-892-8868