Larry W. Crocker Dmd, PC

NPI #1215034608 in Godfrey, Illinois

Provider Information

NPI Number: 1215034608
Entity Type: Organization
Organization Name: Larry W. Crocker Dmd, PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 20, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1317 DADRIAN PROFESSIONAL PARK
City: Godfrey
State: Illinois
ZIP Code: 62035-1686
Phone: (618) 466-0733

Authorized Official

Name: LARRY PRUETT
Title: OFFICE MANAGER
Phone: (618) 466-0733

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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