MEDICARE: VIRGINIA W CROSE D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	N6543	IN

General Provider Information

NPI Number	:	1376551010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA W CROSE D.D.S

Provider Business Mailing Address
First Line	:	1950 WEST 86 STREET
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260
Country	:	US
Telephone Number	:	317-872-7272
Fax Number	:	317-872-7272

Provider Business Practice Location Address
First Line	:	1950 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2076
Country	:	US
Telephone Number	:	317-872-7272
Fax Number	:	317-872-7272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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