NPIMap

Organization Active NPI

Michael S. Crockett, DDS, PC

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1861551210
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D6584 Issued in AZ
Legal business name
MICHAEL S. CROCKETT, DDS, PC
Practice address
31 S 63Rd St
Suite 5
Mesa, AZ 85206-1606
Phone
(480) 981-0203
Fax
(480) 924-5211
NPI assigned
Dec 8, 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
Dr. Michael S. Crockett, D.D.S.NPI 1053335950
Title
President
Phone
(480) 981-0203

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D6584 AZ Primary

Addresses

Primary practice location

31 S 63Rd St
Suite 5
Mesa, AZ 85206-1606

Mailing address

31 S 63Rd St
Suite 5
Mesa, AZ 85206-1606
Phone (480) 981-0203

National Provider Directory

National Provider Directory

Locations

31 S 63rd St
Ste 5
Mesa, AZ 85206
Phone (480) 981-0203

Practitioners & affiliated clinicians

Practitioners 3

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": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861551210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 S 63RD ST",
            "address_2": "SUITE 5",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061606",
            "telephone_number": "480-981-0203",
            "fax_number": "480-924-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 S 63RD ST",
            "address_2": "SUITE 5",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061606",
            "telephone_number": "480-981-0203",
            "fax_number": "480-924-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL S. CROCKETT, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-981-0203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D6584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

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.