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General NPI Number Information
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NPI Number | 1467566018
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Entity Type | Organization
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Legal Business Name | SAMUEL RAY CROSS DDS PA
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 401 DOCTORS CIRCLE
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337
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Country | US
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Telephone | 910-862-2892
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Fax | 910-862-6345
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Provider Business Mailing Address
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Address Line | PO BOX 1736 401 DOCTORS CIRCLE
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337
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Country | US
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Telephone | 910-862-2892
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Fax | 910-862-6345
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL RAY CROSS
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Credential | DDS
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Telephone | 910-862-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4625
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License Number State | NC
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