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Organization
CRYSTAL DENTAL OF BURLESON
Active
Organization
CRYSTAL DENTAL OF BURLESON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN T. LE D.D.S. (DENTIST/OWNER)
(817) 426-3331
Entity
Organization
Contact information
Practice address
664 SW WILSHIRE BLVD, BURLESON, TX 76028-5851
(817) 426-3331
(817) 426-3337
Mailing address
2880 HIGHWAY 157 N, SUITE 102, MANSFIELD, TX 76063-8849
(817) 473-6200
(817) 473-6207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
21298
TX
305R00000X
Preferred Provider Organization
Primary
21298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730177619
—
TX
Enumeration date
03/23/2008
Last updated
07/07/2009
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