Crockett, Mary Whitaker
Crockett, Mary Whitaker is an sole proprietor health care provider with primary practice located at 102 S Venture Dr , Greenville SC 29615-3571. She recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as her primary health care specialty. Crockett, Mary Whitaker can be contacted via phone (864) 234-9800.Contact Information
Primary practice address
102 S Venture Dr
Greenville SC 29615-3571
Phone: (864) 234-9800
Fax: (864) 234-9820
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | SC3486 | South Carolina |
Profile Details
| NPI number | 1194805143 |
|---|---|
| LBN Legal business name | Crockett, Mary Whitaker |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 16th, 2006 |
| Last updated | Jul 9th, 2007 - about 19 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194805143 | NPPES |
| South Carolina | MEDICAID | ZA9507 |
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