National Provider Identifier Database

CRYSTAL DENTAL OF FORT WORTH PC
Preferred Provider Organization

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.


Contact Information

CRYSTAL DENTAL OF FORT WORTH, P.C.
1114 E SEMINARY DR
FORT WORTH, TX76115-2830
Phone: 817-473-6200
Fax:
Website:
Specialty Taxonomy Code
* Preferred Provider Organization 305R00000X

* Indicates primary specialty

NPI Profile & details for CRYSTAL DENTAL OF FORT WORTH, P.C.

NPI Number 1376840306
Legal business name
LBN
CRYSTAL DENTAL OF FORT WORTH, P.C.
Authorized official BRIAN LE - (OWNER/DENTIST)
Entity Organization
Organization subpart No
Enumeration date 02/28/2011
Last updated 02/28/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • TX License #: 21298
  • TX Medicaid: 158687708
  • TX Medicaid: 175019201
  • TX Medicaid: 204803503

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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