=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215991765
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN FRANCIS CRISLER D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 AMERICAN RD SE SUITE 369
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-898-6000
-----------------------------------------------------
Fax | 505-898-6166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 AMERICAN RD SE SUITE 369
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-898-6000
-----------------------------------------------------
Fax | 505-898-6166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DD1275
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------