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General NPI Number Information
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NPI Number | 1619252293
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Entity Type | Organization
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Legal Business Name | TEXAS GRINS FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 136 EL CHICO TRL SUITE 101
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City | WILLOW PARK
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State | TX
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Zip | 76087-8863
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Country | US
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Telephone | 817-441-3232
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Fax | 817-441-2230
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Provider Business Mailing Address
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Address Line | 136 EL CHICO TRL SUITE 101
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City | WILLOW PARK
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State | TX
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Zip | 76087-8863
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Country | US
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Telephone | 817-441-3232
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Fax | 817-441-2230
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER RYAN CRAIN
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Credential | DDS
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Telephone | 817-441-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 22460
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License Number State | TX
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