Provider Demographics
NPI:1497908784
Name:SPRING VALLEY CROSSING DENTAL, P.A.
Entity Type:Organization
Organization Name:SPRING VALLEY CROSSING DENTAL, P.A.
Other - Org Name:BEAR CREEK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-420-7000
Mailing Address - Street 1:14207 COIT ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2839
Mailing Address - Country:US
Mailing Address - Phone:972-490-1600
Mailing Address - Fax:972-490-1620
Practice Address - Street 1:14207 COIT ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-2839
Practice Address - Country:US
Practice Address - Phone:972-490-1600
Practice Address - Fax:972-490-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198700001Medicaid