Kerry Francis Crocken, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12762 Issued in MD

Practice address

122 N Philadelphia Blvd
Route 40
Aberdeen, MD 21001-2513

Phone

(410) 272-2636

Fax

(410) 272-8587

NPI assigned

Dec 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1295918837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 N KELLY AVE",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143617",
            "telephone_number": "610-457-8942",
            "fax_number": "410-272-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 N PHILADELPHIA BLVD",
            "address_2": "ROUTE 40",
            "city": "ABERDEEN",
            "state": "MD",
            "postal_code": "210012513",
            "telephone_number": "410-272-2636",
            "fax_number": "410-272-8587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKEN",
        "first_name": "KERRY",
        "middle_name": "FRANCIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "12762",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Conyers, LGPC
• Brianna Cooper
• Stephanie Correll, M.S. CCC-SLP
• Imani Alexandra Craig, LCSW-C
• Deborah Cristal
• Viviana Cruz Sanabria
• Current Healthcare Affairs LLC
• Dacota Assisted Living
• Harriet Mboni Daraja
• Jocelyn Davis, M.S. CCC-SLP

• General Practice Dentistry in Aberdeen, MD
• Providers in Aberdeen, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.