1356990519 NPI number — 1221 DENTAL FAMILY BUSINESS, PLLC

Table of content: ASHLEY JEAN CRIST LICSW (NPI 1861844250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356990519 NPI number — 1221 DENTAL FAMILY BUSINESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1221 DENTAL FAMILY BUSINESS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356990519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6435 S FM 549 STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEATH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75032-6224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-722-4376
Provider Business Mailing Address Fax Number:
469-264-7148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6435 S FM 549 STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEATH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75032-6224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-722-4376
Provider Business Practice Location Address Fax Number:
469-264-7148
Provider Enumeration Date:
09/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BEABER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
DOUGLASS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-722-4376

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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