MICHAEL S. CROCKETT, DDS, PC
Dentist at 63 St, Mesa, AZ

License number
Arizona D6584
Category
Dentist
Type
General Practice
Owner
Name: DR. MICHAEL S. CROCKETT D.D.S.
Title: PRESIDENT
Phone: (480) 981-0203
Address
Address
31 S 63Rd St SUITE 5, Mesa, AZ 85206
National Provider ID: 1861551210
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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MICHAEL S. CROCKETT, DDS, PC

31 S 63 St #5, Mesa, AZ 85206

Registration:
Oct 21, 2005
State ID:
-1237304-9
Expiration:
Perpetual
President:
Michael S Crockett (President), #5, Mesa, AZ 85206 (Physical)
Agent:
Kent Ellsworth,4824 E Baseline Rd #133, Mesa, AZ 85206 (Physical)
Business type:
Health Care

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