Dr. Jordan P Crocker, DMD
Dentist, General Practice in Vicksburg, MS. Individual provider (NPI-1).
NPI number1982952115
StatusActive
Last updated in NPPESDec 7, 2018
Details
- NPI
- 1982952115
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jordan P Crocker
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 20, 2012
- Last updated
- Dec 7, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 3672-12 | MS | Yes |
Practice location
109 Monument PlVicksburg, MS 39180-5161
Phone 601-638-3661 · Fax 601-631-0401
Mailing address
109 Monument PlVicksburg, MS 39180-5161
Phone 601-638-3661 · Fax 601-631-0401
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All 26 General Practice Dentistry providers in Vicksburg · All 1,002 providers in Vicksburg
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