Provider Demographics
NPI:1619252293
Name:TEXAS GRINS FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:TEXAS GRINS FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-441-3232
Mailing Address - Street 1:136 EL CHICO TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8863
Mailing Address - Country:US
Mailing Address - Phone:817-441-3232
Mailing Address - Fax:817-441-2230
Practice Address - Street 1:136 EL CHICO TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8863
Practice Address - Country:US
Practice Address - Phone:817-441-3232
Practice Address - Fax:817-441-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22460332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment