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General NPI Number Information
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NPI Number | 1821574708
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Entity Type | Individual
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Provider Name | BENJAMIN CROCKETT DMD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 385 S COLUMBIA ST
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City | CHAPEL HILL
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State | NC
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Zip | 27599-0001
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Country | US
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Telephone | 919-537-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 S NEPAL WAY
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City | AURORA
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State | CO
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Zip | 80015-5567
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Country | US
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Telephone | 949-322-7697
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Fax |
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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 | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 51203
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License Number State | NC
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