Individual
DR. JORDAN P CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
109 MONUMENT PL, VICKSBURG, MS 39180-5161
(601) 638-3661
(601) 631-0401
Mailing address
109 MONUMENT PL, VICKSBURG, MS 39180-5161
(601) 638-3661
(601) 631-0401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3672-12
MS
Other
Enumeration date
08/20/2012
Last updated
12/07/2018
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