Healthcare Provider Details

I. General information

NPI: 1124287123
Provider Name (Legal Business Name): HEATHER MARIE CROCKETT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER CROCKETT-MILLER DDS

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PARSONS AVE FL 2
COLUMBUS OH
43215-5331
US

IV. Provider business mailing address

3433 AGLER RD STE 2800
COLUMBUS OH
43219-3389
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-7487
  • Fax: 614-645-7080
Mailing address:
  • Phone: 614-859-1906
  • Fax: 614-458-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.023011
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number010471
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: