Kenneth Detlaf Cross, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS026724L Issued in PA

Practice address

510 Main St
Benton, PA 17814

Phone

(570) 925-5011

Fax

(570) 925-2943

NPI assigned

Aug 17, 2006

Last updated

Apr 3, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459641600000",
    "number": "1982717328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "address_2": "510 MAIN ST",
            "city": "BENTON",
            "state": "PA",
            "postal_code": "17814",
            "telephone_number": "570-925-5011",
            "fax_number": "570-925-2943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 MAIN ST",
            "city": "BENTON",
            "state": "PA",
            "postal_code": "17814",
            "telephone_number": "570-925-5011",
            "fax_number": "570-925-2943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROSS",
        "first_name": "KENNETH",
        "middle_name": "DETLAF",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2016-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS026724L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloomsburg Physicians Services (BPS Benton Family Practice)
• Carlyon Counseling LLC
• Leesa Beth Carlyon, MS, LPC
• Kendra Cituk, RN
• Colpharm Inc (Colonial Pharmacy)
• Ann Smith Depoe, CRNP
• Geisinger Clinic
• John Joseph Hutnick, OD
• Laurie Jeannette Kerschner, CRNP
• Shelby L Kester, LPN

• Dentist in Benton, PA
• Providers in Benton, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.