Provider Demographics
NPI:1386335008
Name:CROCK, EMILY NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:CROCK
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 1:686 CORYLUS DR
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7628
Mailing Address - Country:US
Mailing Address - Phone:740-964-3500
Mailing Address - Fax:740-964-3502
Practice Address - Street 1:686 CORYLUS DR
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7628
Practice Address - Country:US
Practice Address - Phone:740-964-3500
Practice Address - Fax:740-964-3502
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0271181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice