MEDICARE: CURTIS W. CROSS 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	1223G0001X	General Practice Dentistry	18806	CA

General Provider Information

NPI Number	:	1730344722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS W. CROSS D.D.S.

Provider Business Mailing Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 204
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 204
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:	626-330-4548
Fax Number	:

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

Provider Enumeration Date	:	07/19/2008
Last Update Date	:	07/19/2008

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