Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | $$$$$$$$$ | TX |
Y | 1223D0004X | Dentist Anesthesiologist | 30809 | TX |
NPI | 1902168602 |
---|---|
Provider Name | Dr. Jennifer Cross |
First Address | Fort Worth, TX 76133-7827 |
Second Address | Fort Worth, TX 76133-7827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2012 |
Last Update Date | 14/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
348644101 | (05) | TX |
3486441-02 | (05) | TX |