Crockett Pediatric Dentistry, P.A.

LBN: Crockett Pediatric Dentistry, P.A.
Crockett Pediatric Dentistry, P.A. is an health care organization with primary practice located at 102 S Venture Dr , Greenville SC 29615-3571. The organization recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as the primary health care specialty. Crockett Pediatric Dentistry, P.A. can be contacted via phone (864) 234-9800, or through Crockett, Jerry W. 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:
Map and Directions
Authorized official contact:
Name: Crockett, Jerry W.
Phone: (864) 234-9800

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X SC3486 South Carolina

Profile Details

NPI number 1124245626
LBN Legal business name Crockett Pediatric Dentistry, P.A.
DBA Doing business as
Authorized official Crockett, Jerry W.
Entity Organization
Organization subpart 1 No
Enumeration date Apr 19th, 2007
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124245626 NPPES
South Carolina MEDICAID ZA9507

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