Provider Demographics
NPI:1033591359
Name:CROWN POINTE DENTISTRY, PA
Entity Type:Organization
Organization Name:CROWN POINTE DENTISTRY, PA
Other - Org Name:ALEDO DENTAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-441-7654
Mailing Address - Street 1:220 SHOPS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087
Mailing Address - Country:US
Mailing Address - Phone:817-441-7654
Mailing Address - Fax:
Practice Address - Street 1:220 SHOPS BLVD
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087
Practice Address - Country:US
Practice Address - Phone:817-441-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty