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Organization
JORDAN P. CROCKER, D.M.D., PLLC
Active
Organization
JORDAN P. CROCKER, D.M.D., PLLC
Active
Other names
Crocker Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN P CROCKER D.M.D. (OWNER)
(601) 638-3661
Entity
Organization
Contact information
Practice address
109 MONUMENT PLACE, VICKSBURG, MS 39180
(601) 638-3661
(601) 631-0401
Mailing address
109 MONUMENT PLACE, VICKSBURG, MS 39180
(601) 638-3661
(601) 631-0401
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3672-12
MS
Other
Enumeration date
08/29/2014
Last updated
01/09/2019
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