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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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