Mary Whitaker Crockett, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

SC3486 Issued in SC

Practice address

102 S Venture Dr
Greenville, SC 29615-3571

Phone

(864) 234-9800

Fax

(864) 234-9820

NPI assigned

Oct 16, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crockett Pediatric Dentistry, P.a.

  • Pediatric Dentistry
  • Greenville, SC
  • NPI 1124245626
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1194805143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S VENTURE DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153571",
            "telephone_number": "864-234-9800",
            "fax_number": "864-234-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S VENTURE DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153571",
            "telephone_number": "864-234-9800",
            "fax_number": "864-234-9820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "MARY",
        "middle_name": "WHITAKER",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "SC3486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9507",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Nuckolls Crittenden, COTA/L
• Karsyn Blanton Crocker M.S., CCC-SLP
• Crockett Pediatric Dentistry, P.a.
• Amy Hairston Crockett, M.D.
• Jay Anton Crockett, M.D.
• Michele Marie Crockett, RN
• Tabatha Crockett
• Michael Crogan
• Sara Kalyn Croker
• Cromer Family Chiropractic

• Pediatric Dentistry in Greenville, SC
• Providers in Greenville, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.