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NPI Code Detail

MEDICARE: CRYSTAL DENTAL CARE PLLC

MEDICARE: CRYSTAL DENTAL CARE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist31916TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131916OTHERTXTEXAS STATE BOARD OF DENTAL EXAMINERS

General Provider Information

NPI Number : 1306353628
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRYSTAL DENTAL CARE PLLC
Provider Business Mailing Address
First Line : 5565 MANSIONS BLFS APT 4301
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78245-0019
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 402 E ZAVALA ST STE 1
Second Line :
City : CRYSTAL CITY
State : TX
Zip : 78839-3337
Country : US
Telephone Number : 830-326-2740
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. VIVEK SINGH
Credential : DDS
Telephone Number : 830-326-2740
Provider Enumeration Date : 01/08/2018
Last Update Date : 01/08/2018

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