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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 Specialty Code Provider Type

Preferred Provider Organization

305R00000X
Indicates primary specialty

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

NPI # 1376840306
LBN Legal business name CRYSTAL DENTAL OF FORT WORTH, P.C.
Authorized official BRIAN LE - (OWNER/DENTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 02/28/2011
Last updated 02/28/2011 - About 15 years ago
Identifiers
TX License # 21298
TX Medicaid 158687708
TX Medicaid 175019201
TX Medicaid 204803503
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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