Provider Demographics
NPI:1518975986
Name:CROCKETT, JAMES DONALD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DONALD
Last Name:CROCKETT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:DONALD
Other - Last Name:CROCKETT
Other - Suffix:V
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5206 CEDAR ST
Mailing Address - Street 2:5206 CEDAR STREET
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3915
Mailing Address - Country:US
Mailing Address - Phone:713-663-7171
Mailing Address - Fax:713-666-3454
Practice Address - Street 1:5206 CEDAR ST
Practice Address - Street 2:5206 CEDAR STREET
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3915
Practice Address - Country:US
Practice Address - Phone:713-663-7171
Practice Address - Fax:713-666-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice