Organization
ABC123 DENTAL IN CROWLEY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ANGELA FLORES (OFFICE MANAGER)
(817) 496-2343
Entity
Organization
Contact information
Practice address
200 E MAIN ST STE C, CROWLEY, TX 76036-2600
(817) 496-2343
(817) 665-3822
Mailing address
6426 MEADOWBROOK DR, FORT WORTH, TX 76112-5123
(817) 496-2343
(817) 665-3822
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
24570
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558597963
—
TX
Enumeration date
03/03/2014
Last updated
03/03/2014
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