Provider Demographics
NPI:1144209602
Name:CROOKER, GREGORY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:K
Last Name:CROOKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11705 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2928
Mailing Address - Country:US
Mailing Address - Phone:913-451-2222
Mailing Address - Fax:
Practice Address - Street 1:4627 SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-3648
Practice Address - Country:US
Practice Address - Phone:913-677-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS63901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice