# A BEAUTIFUL SMILE MEANS A BETTER LIFE 3

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

## Provider details

- **NPI number:** 1356518310
- **Authorized official:** GARY R CROCKETT DDS (OWNER)
- **Authorized official phone:** (562) 430-2740

## Contact information

- **Practice address:** 5512 BRITTON DR STE 208, LONG BEACH, CA 90815
- **Practice address phone:** (562) 430-2740
- **Practice address fax:** (562) 430-0466
- **Mailing address:** 5512 BRITTON DR STE 208, LONG BEACH, CA 90815
- **Mailing address phone:** (562) 430-2740
- **Mailing address fax:** (562) 430-0466

## Taxonomy

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

## Other

- **Enumeration date:** 05/09/2008
- **Last updated:** 05/09/2008