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

Crockett Pediatric Dentistry, PA

Organization Pediatric Dentistry · NPI 1124245626

Crockett Pediatric Dentistry, PA is a 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.

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Practice location Address checks out

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