Provider Demographics
NPI:1295918837
Name:CROCKEN, KERRY FRANCIS (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:FRANCIS
Last Name:CROCKEN
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 1:19 N KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3617
Mailing Address - Country:US
Mailing Address - Phone:610-457-8942
Mailing Address - Fax:410-272-8587
Practice Address - Street 1:122 N PHILADELPHIA BLVD
Practice Address - Street 2:ROUTE 40
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2513
Practice Address - Country:US
Practice Address - Phone:410-272-2636
Practice Address - Fax:410-272-8587
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12762122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist