OrganizationActive
Jordan P. Crocker, D.M.D., PLLC
NPI 1962802710 · Dental Clinic/Center · Vicksburg, MS
Provider details
- NPI number
- 1962802710
- Entity type
- Organization
- Primary specialty
- Dental Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jordan Crocker, Owner(601) 638-3661
- License
- 3672-12 (MS)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(75/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
109 Monument Place
Vicksburg, MS 39180
Phone: (601) 638-3661
Fax: (601) 631-0401
Street-level locationGet directions
Mailing address
109 Monument Place
Vicksburg, MS 39180
Other names (DBA / former)
- Doing business as
- Crocker Family Dental
Registry dates
- Enumerated
- 2014-08-29
- Last updated
- 2019-01-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.