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Contact Information

CRYSTAL DENTAL OF BURLESON
664 SW WILSHIRE BLVD
BURLESON, TX76028-5851
 Phone: 817-426-3331
 Fax: 817-426-3337
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Preferred Provider Organization

305R00000X
 

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for CRYSTAL DENTAL OF BURLESON

NPI # 1508037128
LBN Legal business name CRYSTAL DENTAL OF BURLESON
Authorized official BRIAN LE - (DENTIST/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/23/2008
Last updated 07/07/2009 - About 17 years ago
Identifiers
TX License # 21298
TX Medicaid 1730177619
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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