Individual
MICHAEL CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
31 S 63RD ST, SUITE 5, MESA, AZ 85206-1606
(480) 981-0203
Mailing address
3283 E WASHINGTON AVE, GILBERT, AZ 85234-4103
(480) 588-6562
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6584
AZ
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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