Provider Demographics
NPI:1699224956
Name:MESQUITE CROSSING DENTAL, PA
Entity Type:Organization
Organization Name:MESQUITE CROSSING DENTAL, PA
Other - Org Name:BEAR CREEK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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:PO BOX 541448
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75354-1448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2110 N GALLOWAY AVE
Practice Address - Street 2:SUITE 104-105
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5713
Practice Address - Country:US
Practice Address - Phone:214-420-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty