Jordan P. Crocker, D.m.d., Pllc
NPI #1962802710 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1962802710
- Entity Type
- Organization
- Organization Name
- Jordan P. Crocker, D.m.d., Pllc
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Aug 29, 2014
- Last Updated
- Jan 9, 2019
Practice Location
- Address
- 109 MONUMENT PLACE
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39180
- Phone
- (601) 638-3661
Authorized Official
- Name
- DR. JORDAN P CROCKER, D.M.D.
- Title
- OWNER
- Phone
- (601) 638-3661
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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