Organization
MICHELLE C. CROCKER, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE C CROCKER DMD (PRESIDENT)
(503) 515-6092
Entity
Organization
Contact information
Practice address
11786 SW BARNES RD STE 320, PORTLAND, OR 97225-5930
(503) 641-3550
Mailing address
13195 SW SHORE DR, TIGARD, OR 97223-1683
(503) 641-3550
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8443
OR
Other
Enumeration date
05/02/2010
Last updated
05/02/2010
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