MEDICARE: DR. DANNY BRANDON CROCKARELL DDS

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	4336	TN

General Provider Information

NPI Number	:	1932263167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNY BRANDON CROCKARELL DDS

Provider Business Mailing Address
First Line	:	101 COUCHVILLE PIKE
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-4728
Country	:	US
Telephone Number	:	615-714-6312
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 COUCHVILLE PIKE
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-4728
Country	:	US
Telephone Number	:	615-714-6312
Fax Number	:

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	06/27/2024

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