# A BEAUTIFUL SMILE MEANS A BETTER LIFE 2

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

## Provider details

- **NPI number:** 1154588895
- **Authorized official:** GARY R CROCKETT DDS (OWNER)
- **Authorized official phone:** (562) 861-0496

## Contact information

- **Practice address:** 11411 BROOKSHIRE AVE STE 405, DOWNEY, CA 90241
- **Practice address phone:** (562) 861-0496
- **Practice address fax:** (562) 861-4153
- **Mailing address:** 11411 BROOKSHIRE AVE STE 405, DOWNEY, CA 90241
- **Mailing address phone:** (562) 861-0496
- **Mailing address fax:** (562) 861-4153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 20092 | CA | Yes |
| 1223G0001X | General Practice Dentistry | 50687 | CA | — |

## Other

- **Enumeration date:** 05/20/2008
- **Last updated:** 05/20/2008