Provider Demographics
NPI:1932263167
Name:CROCKARELL, DANNY BRANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:BRANDON
Last Name:CROCKARELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COUCHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4728
Mailing Address - Country:US
Mailing Address - Phone:615-714-6312
Mailing Address - Fax:
Practice Address - Street 1:101 COUCHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4728
Practice Address - Country:US
Practice Address - Phone:615-714-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice