Healthcare Provider Details

I. General information

NPI: 1619988037
Provider Name (Legal Business Name): MARIE CROCKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 VENANGO AVE
CAMBRIDGE SPRINGS PA
16403
US

IV. Provider business mailing address

750 VENANGO AVE
CAMBRIDGE SPRINGS PA
16403
US

V. Phone/Fax

Practice location:
  • Phone: 814-398-2656
  • Fax: 814-398-1438
Mailing address:
  • Phone: 814-398-2656
  • Fax: 814-398-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS028556L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: