NPI 1376840306

Crystal Dental of Fort Worth, P.C.

Organisation Preferred Provider Organization Fort Worth, TX

Practice location

Address: 1114 E Seminary Dr, Fort Worth, TX 76115-2830
Phone: (817) 473-6200
Mailing address: 2880 Highway 157 N STE 102, Mansfield, TX 76063-8849

Authorised official

Name: Brian T Le
Title: Owner/Dentist
Phone: (817) 793-0013

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 21298 (TX)

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Registry record

NPI: 1376840306
Entity type: Organization
NPI issued: 28 Feb 2011
Record last updated: 28 Feb 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.