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General NPI Number Information
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NPI Number | 1982237533
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Entity Type | Individual
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Provider Name | JESSICA R CROXTON DMD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 117 FIRST NATIONAL DR
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City | DALLAS
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State | GA
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Zip | 30157-3430
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Country | US
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Telephone | 770-505-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 2349 WILLIAMS ST UNIT 111
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City | AUGUSTA
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State | GA
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Zip | 30904-6192
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Country | US
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Telephone | 479-571-0216
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN016101
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License Number State | GA
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