Crystal Dental Of Fort Worth, P.C.

LBN: Crystal Dental Of Fort Worth, P.C.
Crystal Dental Of Fort Worth, P.C. is an health care organization with primary practice located at 1114 E Seminary Dr , Fort Worth TX 76115-2830. The organization recently has only one registered license in Managed Care Organizations / Preferred Provider Organization, which is considered as the primary health care specialty. Crystal Dental Of Fort Worth, P.C. can be contacted via phone (817) 473-6200, or through Le, Brian T via phone (817) 793-0013.

Contact Information

Primary practice address
1114 E Seminary Dr Fort Worth TX 76115-2830
Phone: (817) 473-6200
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Le, Brian T Doctor of Dental Surgery (DDS)
Phone: (817) 793-0013

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Preferred Provider Organization 305R00000X 21298 Texas

Profile Details

NPI number 1376840306
LBN Legal business name Crystal Dental Of Fort Worth, P.C.
DBA Doing business as
Authorized official Le, Brian T Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 28th, 2011
Last updated Feb 28th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376840306 NPPES
Texas MEDICAID 158687708
Texas MEDICAID 175019201
Texas MEDICAID 204803503

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