Provider Demographics
NPI:1609920990
Name:LEONARD E. CRABTREE, D.D.S., INC.
Entity Type:Organization
Organization Name:LEONARD E. CRABTREE, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-623-0700
Mailing Address - Street 1:1011 AUGUSTA DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2062
Mailing Address - Country:US
Mailing Address - Phone:713-623-0700
Mailing Address - Fax:713-977-1190
Practice Address - Street 1:1011 AUGUSTA DR
Practice Address - Street 2:SUITE 209
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2062
Practice Address - Country:US
Practice Address - Phone:713-623-0700
Practice Address - Fax:713-977-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R638OtherBLUE CROSS BLUE SHIELD
TX789132OtherUNITED CONCORDIA