Provider Demographics
NPI:1235850074
Name:CRABTREE PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:CRABTREE PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-293-8610
Mailing Address - Street 1:3801 W FINANCIAL PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1499
Mailing Address - Country:US
Mailing Address - Phone:479-370-0101
Mailing Address - Fax:
Practice Address - Street 1:3801 W FINANCIAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1499
Practice Address - Country:US
Practice Address - Phone:479-370-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty