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General NPI Number Information
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NPI Number | 1124287123
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Entity Type | Individual
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Provider Name | HEATHER MARIE CROCKETT DDS
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Gender | Female
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 240 PARSONS AVE FL 2
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City | COLUMBUS
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State | OH
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Zip | 43215-5331
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Country | US
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Telephone | 614-645-7487
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Fax | 614-645-7080
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Provider Business Mailing Address
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Address Line | 3433 AGLER RD STE 2800
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City | COLUMBUS
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State | OH
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Zip | 43219-3389
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Country | US
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Telephone | 614-859-1906
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Fax | 614-458-1849
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.023011
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 010471
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License Number State | CT
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