# SPA DENTAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013090034
- **Authorized official:** DR. MARIE D CROCKER D.D.S. (OWNER)
- **Authorized official phone:** (814) 398-2656

## Contact information

- **Practice address:** 750 VENANGO AVE, CAMBRIDGE SPRINGS, PA 16403
- **Practice address phone:** (814) 398-2656
- **Practice address fax:** (814) 398-1438
- **Mailing address:** 750 VENANGO AVE, CAMBRIDGE SPRINGS, PA 16403
- **Mailing address phone:** (814) 398-2656
- **Mailing address fax:** (814) 398-1438

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS028556L | PA | Yes |
| 1223G0001X | General Practice Dentistry | DS017224L | PA | — |
| 1223G0001X | General Practice Dentistry | DS028556L | PA | — |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 03/09/2011