Organization
CREST FAMILY DENTAL FORT WORTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAN CHI LE DDS (MANAGING MEMBER)
(214) 350-8800
Entity
Organization
Contact information
Practice address
220 E SEMINARY DR, SUITE 100, FORT WORTH, TX 76115-2607
(817) 484-6468
Mailing address
2823 KENDALE DR, DALLAS, TX 75220-4736
(214) 350-8800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22755
TX
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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