Provider Demographics
NPI:1528797081
Name:CROCKER, MEGAN (DDS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CROCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 RIVER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4815
Mailing Address - Country:US
Mailing Address - Phone:325-668-3654
Mailing Address - Fax:
Practice Address - Street 1:9595 SIX PINES DR STE 6260
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1551
Practice Address - Country:US
Practice Address - Phone:281-298-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice