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General NPI Number Information
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NPI Number | 1497035315
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Entity Type | Organization
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Legal Business Name | CROWN ORTHODONTICS
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 2729 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-3114
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Country | US
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Telephone | 214-549-4340
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 KIMBALL HILL CT
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7914
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Country | US
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Telephone | 214-549-4340
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANURAG PATEL
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Credential | DMD, MS ED
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Telephone | 214-549-4340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 23218
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License Number State | TX
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