| Crystal Dental Of Burleson | |
|
664 Sw Wilshire Blvd Burleson TX 76028-5851 | |
| (817) 426-3331 | |
| (817) 426-3337 |
| Full Name | Crystal Dental Of Burleson |
|---|---|
| Speciality | Preferred Provider Organization |
| Location | 664 Sw Wilshire Blvd, Burleson, Texas |
| Authorized Official Name and Position | Brian T. Le (DENTIST/OWNER) |
| Authorized Official Contact | 8174263331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Dental Of Burleson 2880 Highway 157 N Suite 102 Mansfield TX 76063-8849 Ph: (817) 473-6200 | Crystal Dental Of Burleson 664 Sw Wilshire Blvd Burleson TX 76028-5851 Ph: (817) 426-3331 |
| NPI Number | 1508037128 |
|---|---|
| Provider Enumeration Date | 03/23/2008 |
| Last Update Date | 07/07/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508037128 | NPI | - | NPPES |
| 1730177619 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 21298 (Texas) | Secondary |
| 305R00000X | Preferred Provider Organization | 21298 (Texas) | Primary |
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