OrganizationActive
Crockett Pediatric Dentistry, P.A.
NPI 1124245626 · Pediatric Dentistry · Greenville, SC
Provider details
- NPI number
- 1124245626
- Entity type
- Organization
- Primary specialty
- Pediatric DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Jerry Crockett, Business Manager(864) 234-9800
- License
- SC3486 (SC)
Specialties & taxonomies
Dental Providers
Practice location
102 S Venture Dr
Greenville, SC 29615-3571
Phone: (864) 234-9800
Fax: (864) 234-9820
Approximate (ZIP-level) locationGet directions
Mailing address
102 S Venture Dr
Greenville, SC 29615-3571
Registry dates
- Enumerated
- 2007-04-19
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.