MEDICARE: DR. GREGORY K. CROOKER D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6390	KS

General Provider Information

NPI Number	:	1144209602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY K. CROOKER D.D.S

Provider Business Mailing Address
First Line	:	11705 CANTERBURY CT
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66211-2928
Country	:	US
Telephone Number	:	913-451-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4627 SHAWNEE DR
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-3648
Country	:	US
Telephone Number	:	913-677-1004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	09/11/2009

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