Crocker, Jordan P

Crocker, Jordan P is an individual health care provider with primary practice located at 109 Monument Pl , Vicksburg MS 39180-5161. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Crocker, Jordan P can be contacted via phone (601) 638-3661.

Contact Information

Primary practice address
109 Monument Pl Vicksburg MS 39180-5161
Phone: (601) 638-3661
Fax: (601) 631-0401
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 3672-12 Mississippi

Profile Details

NPI number 1982952115
LBN Legal business name Crocker, Jordan P
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2012
Last updated Dec 7th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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