JORDAN P. CROCKER, D.M.D., PLLC

NPI # 

Practice Address:

109 Monument Place

Vicksburg, MS, 39180

Practice Phone:

601-638-3661

Practice Fax:

601-631-0401

License Number:

3672-12

License State:

MS

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Dental

Taxonomy Code:

261QD0000X

Updated by NPPES on 1/9/2019. You can view the original data set for NPI # 1962802710 on the official NPPES website. If the information about this NPI provider/company is outdated you can request updates through the NPPES website. See our FAQ page for more information.

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JORDAN P. CROCKER, D.M.D., PLLC's

CMS CPT® coding data

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