Healthcare Provider Details

I. General information

NPI: 1336297563
Provider Name (Legal Business Name): DAN CRAWFORD GEN. PARTNER CO KRIS WORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E HIGHWAY 114 SUITE 170
TROPHY CLUB TX
76262-6684
US

IV. Provider business mailing address

2001 E HIGHWAY 114 SUITE 170
TROPHY CLUB TX
76262-6684
US

V. Phone/Fax

Practice location:
  • Phone: 817-359-3800
  • Fax:
Mailing address:
  • Phone: 817-359-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18171
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17972
License Number StateTX

VIII. Authorized Official

Name: DR. KRIS ANN WORD
Title or Position: OWNER PARTNER
Credential: D.D.S.
Phone: 972-359-3800