NPIMap

Organization Active NPI

Larry W. Crocker DMD, PC

Doing business as Dentistry with TLC

  • General Practice Dentistry
  • Godfrey, IL
National Provider Identifier
1215034608
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LARRY W. CROCKER DMD, PC
Doing business as
Dentistry with TLC
Practice address
1317 Dadrian Professional Park
Godfrey, IL 62035-1686
Phone
(618) 466-0733
Fax
(618) 466-1433
NPI assigned
Sep 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Larry Pruett
Title
Office Manager
Phone
(618) 466-0733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X IL Primary

Addresses

Primary practice location

1317 Dadrian Professional Park
Godfrey, IL 62035-1686

Mailing address

1317 D' Adrian Professional Park
Godfrey, IL 62035
Phone (618) 466-0733

Other names 1

  • Dentistry with TLC Doing business as

National Provider Directory

National Provider Directory

Locations

1317 Dadrian Professional Park
Godfrey, IL 62035
Phone (618) 466-0733

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215034608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 D' ADRIAN PROFESSIONAL PARK",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "62035",
            "telephone_number": "618-466-0733",
            "fax_number": "618-466-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 DADRIAN PROFESSIONAL PARK",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620351686",
            "telephone_number": "618-466-0733",
            "fax_number": "618-466-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY W. CROCKER DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRUETT",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-466-0733"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentistry with TLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Godfrey, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.