Organization
BRIAN E. CROCK DDS MS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN E CROCK DDS, MS (PRESIDENT)
(740) 344-3372
Entity
Organization
Contact information
Practice address
175 MCMILLEN DR, NEWARK, OH 43055-1810
(740) 344-3372
Mailing address
175 MCMILLEN DR, NEWARK, OH 43055-1810
(740) 344-3372
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0970436
—
OH
Enumeration date
04/08/2008
Last updated
04/08/2008
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