DR. MARY WHITAKER CROCKETT (NPI# 1194805143) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194805143 |
| Entity Type | Individual |
| Full Name | DR. MARY WHITAKER CROCKETT |
| Credential | D.M.D. |
| Practice Address |
102 S Venture Dr Greenville SC 29615-3571 |
| Practice Telephone | 8642349800 |
| Practice Fax Number | 8642349820 |
| Mailing Telephone | 8642349800 |
| Mailing Fax Number | 8642349820 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
SC3486 | SC | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | ZA9507 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407365661 | Mary Jane Crockett | Driver | 1233 Irvington Rd, Weems, VA 22576-2217 | 2017-09-20 |
| 1831426980 | Mary Alice Crockett | Internal Medicine | 10700 Alloway Dr, Potomac, MD 20854-1601 | 2009-11-11 |
| 1245325653 | Mary M Crockett | Counselor | 42 South Park Street, Bradford, MA 01835 | 2006-10-03 |
| 1417160169 | Mary J Crockett | Occupational Therapist | 1800 New York Ave, Superior, WI 54880 | 2007-05-08 |
| Street Address |
102 S VENTURE DR |
| City | GREENVILLE |
| State | SC |
| Zip Code | 29615-3571 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124245626 | Crockett Pediatric Dentistry, P.a. | Dentist | 102 S Venture Dr, Greenville, SC 29615-3571 | 2007-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358051 | Adenike Orogade | Behavior Technician | 17 Caldedon Ct, Suite B, Greenville, SC 29615 | 2020-02-19 |
| 1629608369 | Jennifer Jacobsen | Behavior Technician | 17 Caldedon Court, Suite B, Greenville, SC 29615 | 2020-01-22 |
| 1932668217 | Carolina Orthopaedic and Neurosurgical Associates | Orthopaedic Surgery | Carolina Orthopaedic and Neurosurgical Associates, 220 Roper Mountain Road Extension, Greenville, SC 29615 | 2019-03-18 |
| 1255816070 | Trevis L Cureton | Pharmacist | 2401 East North St, Greenville, SC 29615 | 2018-09-27 |
| 1497232565 | Jacob J Fountain | Nurse Practitioner | 225 Enterprise Blvd, Suite 101, Greenville, SC 29615 | 2018-07-23 |
| 1346726924 | St. Francis Physician Services, Inc | Internal Medicine | 5 Hoke Smith Blvd, Greenville, SC 29615 | 2018-07-17 |
| 1558853101 | Alexandra Michelle Taylor | Audiologist | 200 Patewood Dr Ste 400, Greenville, SC 29615 | 2018-05-30 |
| 1316466543 | Mariah Hope Mosher | Behavioral Analyst | 7 Mckenna Commons Court, Greenvilee, SC 29615 | 2017-09-19 |
| 1326400896 | Karen L Heaps | Counselor | 3150 S. Hwy 14, The Pelham Center, Greenville, SC 29615 | 2016-03-24 |
| 1134589013 | Sharon Erk | Technician, Other | 2950 E.norths St, Greenville, OH 29615 | 2016-03-04 |
| Find all providers in zip 29615 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699208488 | Greenville Tiny Teeth Pllc | Dentist | 3206 I 30, Suite C, Greenville, TX 75402-7000 | 2017-04-07 |
| 1275780454 | Upstate Pediatric Dentistry, Pa | Dentist | 105-a Halton Road, Greenville, SC 29607-3507 | 2008-08-19 |
| 1558532028 | Pediatric Dental Specialists | Dentist | 1540 S Main St, Suite C, Greenville, MS 38701-7055 | 2008-03-12 |
| 1003022930 | Greenville Pediatric Dentistry, P.a. | Dentist | 3101 Joe Ramsey Blvd E, Suite 103a, Greenville, TX 75401-7716 | 2007-05-15 |
| 1508956632 | April Dunlap Czarsty | Dentist | 1376 Cleveland St, Greenville, SC 29607-2435 | 2006-10-12 |
| 1518986496 | Jennifer L Garvey | Dentist | 100 Regent Park Ct, Greenville, SC 29607-6534 | 2006-07-19 |
| 1386689974 | William Neil Quinton | Dentist | 837 S Main St, Greenville, MS 38701-5871 | 2006-06-18 |
| 1902884984 | Pediatric Dentistry of Greenville,p.a. | Dentist | 410a Pelham Rd, Greenville, SC 29615-3502 | 2006-01-09 |
| 1790771871 | Glenn Robert Head | Dentist | 6 Pointe Cir, Greenville, SC 29615-3506 | 2005-09-23 |
| 1154824324 | Michael Benham Thompson | Dentist | 545 Verdae Blvd Ste A, Greenville, SC 29607-4021 | 2018-03-14 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 29615 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.