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CROCKETT PEDIATRIC DENTISTRY, P.A.
NPI 1124245626
Dentist - Pediatric Dentistry in Greenville, SC

Active since April 19, 2007
102 S VENTURE DR, GREENVILLE, SC 29615(864) 234-9800(864) 234-9820 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Crockett Pediatric Dentistry, P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CROCKETT PEDIATRIC DENTISTRY, P.A. (NPI 1124245626) is a healthcare organization registered as a pediatric dentistry in Greenville, South Carolina and active in the NPI registry since April 2007. The organization lists Jerry W. Crockett, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1124245626
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameCROCKETT PEDIATRIC DENTISTRY, P.A.
Location Address102 S VENTURE DRGreenville, SC 29615-3571
Mailing Address102 S Venture DrGreenville, SC 29615-3571 · (864) 234-9800 · Fax (864) 234-9820
Phone(864) 234-9800
Fax(864) 234-9820
Organization SubpartNo
Authorized OfficialJerry W. CrockettBusiness Manager · (864) 234-9800
Enumeration DateApril 19, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1124245626 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in SC · SC3486
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
102 S VENTURE DR, Greenville, SC 29615
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Other Identifiers 1

MedicaidZA9507SC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. NICOLE BATE PRUITT DMD
Dentist (Pediatric Dentistry)
102 S VENTURE DR
GREENVILLE, SC 29615
Greenville County (864) 234-9800
DR. MARY WHITAKER CROCKETT D.M.D.
Dentist (Pediatric Dentistry)
102 S VENTURE DR
GREENVILLE, SC 29615
Greenville County (864) 234-9800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crockett Pediatric Dentistry, P.A.'s NPI number?

The NPI number for Crockett Pediatric Dentistry, P.A. is 1124245626. It was assigned to this organization in the NPPES registry on April 19, 2007.

Where is Crockett Pediatric Dentistry, P.A. located?

Crockett Pediatric Dentistry, P.A. is located at 102 S Venture Dr, Greenville, SC 29615. The listed phone number is (864) 234-9800.

What is Crockett Pediatric Dentistry, P.A.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Crockett Pediatric Dentistry, P.A. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.