Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Crockett Pediatric Dentistry, PA

Organization Pediatric Dentistry · NPI 1124245626

Crockett Pediatric Dentistry, PA provides Pediatric Dentistry in Greenville, South Carolina. Licensed in South Carolina. Registered with an NPI since 2007.

Licensed in
SC
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

102 S Venture Dr
Greenville, SC 29615-3571
Phone: (864) 234-9800
Fax: (864) 234-9820
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Dentistry (primary) Taxonomy 1223P0221X · Licence SC3486 (SC)

Record details

NPI number1124245626
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jerry Crockett — Business Manager · (864) 234-9800
NPI enumeratedApril 19, 2007
Last updated in NPPESAugust 22, 2020
Mailing address102 S Venture Dr, Greenville, SC 29615-3571

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