Provider Demographics
NPI:1902827926
Name:DOUG CROSBY DDS,MS
Entity Type:Organization
Organization Name:DOUG CROSBY DDS,MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:972-680-9882
Mailing Address - Street 1:1920 N COIT RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2832
Mailing Address - Country:US
Mailing Address - Phone:972-680-9882
Mailing Address - Fax:972-680-8175
Practice Address - Street 1:1920 N COIT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2832
Practice Address - Country:US
Practice Address - Phone:972-680-9882
Practice Address - Fax:972-680-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13073302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization