Lily B and Samuel D Crocco DMD PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LILY B AND SAMUEL D CROCCO DMD PLLC

Practice address

358 Front Ave NW
Castle Rock, WA 98611-8996

Phone

(760) 750-0087

NPI assigned

Aug 19, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lily Crocco, DMDNPI 1780255539

Title

Owner Dentist

Phone

(760) 750-0087

Specialties & licenses 1

Addresses

Other names 1

• Cowlitz River Dental Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lily Barbosa Crocco, DMD

  • Dental Clinic/Center
  • Castle Rock, WA
  • NPI 1780255539
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1053143073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25642 BERRYHILL RD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995779603",
            "telephone_number": "760-750-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 FRONT AVE NW",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "986118996",
            "telephone_number": "760-750-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILY B AND SAMUEL D CROCCO DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "CROCCO",
        "authorized_official_first_name": "LILY",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "760-750-0087",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cowlitz River Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lester Blaine Kennington, DDS
• Trinity Lynn Klecker
• Kleine Enterprises
• L. Blaine Kennington, DDS, PC
• Stephanie Larsen, RN
• Allison Lunday, PT, DPT
• Bethany L Madden, ARNP
• Lynda Jean McLaughlin, CDPT
• Sean Noel Murray, FNP-BC
• Peacehealth

• Dental Clinic/Center in Castle Rock, WA
• Providers in Castle Rock, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.