Active NPI
Deidre Berger Crockett, D.M.D.
- General Practice Dentistry
- Columbia, SC
National Provider Identifier
1003978099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4192
- Practice address
- 5251 Forest Dr
Columbia, SC 29206-4920 - Phone
- (803) 787-9793
- Fax
- (803) 738-0300
- NPI assigned
- Dec 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4192 | SC | Primary |
Addresses
Primary practice location
5251 Forest Dr
Columbia, SC 29206-4920
Mailing address
5251 Forest Dr
Columbia, SC 29206-4920
Phone (803) 787-9793
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4192 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| D. Berger Dental of Elgin P.a. | General Practice | Current | Accepting new patients |
| Berger Dental Group, P.a. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Elgin, SC
- NPI 1063129955
-
- General Practice Dentistry
- Columbia, SC
- NPI 1922070051
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003978099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5251 FOREST DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292064920",
"telephone_number": "803-787-9793",
"fax_number": "803-738-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5251 FOREST DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292064920",
"telephone_number": "803-787-9793",
"fax_number": "803-738-0300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKETT",
"first_name": "DEIDRE",
"middle_name": "BERGER",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "4192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.