Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Crockett Pediatric Dentistry, P.A.

Pediatric Dentistry in Greenville, SC · enumerated 2007 · authorized official Jerry Crockett, Business Manager.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1124245626

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Registry record

Entity type Organization (Type 2)

Legal business name Crockett Pediatric Dentistry, P.A.

Practice address 102 S Venture Dr, Greenville, SC, 29615

Phone (864) 234-9800

Fax (864) 234-9820

Enumeration date Apr 19, 2007

Last updated in NPPES Aug 22, 2020

Taxonomy & classification

1223P0221X Pediatric Dentistry Dental Providers · License SC3486 (SC) Primary

Authorized official

Name Jerry Crockett

Title Business Manager

Phone (864) 234-9800

Other identifiers

Identifier	Type	State	Issuer
ZA9507	Medicaid	SC	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

Where is Crockett Pediatric Dentistry, P.A. located?

The practice location on file with NPPES is in Greenville, SC.

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2020-08-22. Verify at npiregistry.cms.hhs.gov.

Providers at this address

Browse all →

Nicole Pruitt Pediatric Dentistry · Greenville, SC NPI 1104897206 Mary Crockett Pediatric Dentistry · Greenville, SC NPI 1194805143

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2020-08-22.