| NPI | 1962802710 |
|---|---|
| Doing Business As | CROCKER FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | JORDAN P CROCKER Owner 601-638-3661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS 3672-12) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2019-01-09 |