Organization
A BEAUTIFUL SMILE MEANS A BETTER LIFE 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY R CROCKETT DDS (OWNER)
(562) 861-0496
Entity
Organization
Contact information
Practice address
11411 BROOKSHIRE AVE STE 405, DOWNEY, CA 90241
(562) 861-0496
(562) 861-4153
Mailing address
11411 BROOKSHIRE AVE STE 405, DOWNEY, CA 90241
(562) 861-0496
(562) 861-4153
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20092
CA
1223G0001X
General Practice Dentistry
50687
CA
Other
Enumeration date
05/20/2008
Last updated
05/20/2008
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