Provider Demographics
NPI:1336297563
Name:DAN CRAWFORD GEN. PARTNER CO KRIS WORD
Entity Type:Organization
Organization Name:DAN CRAWFORD GEN. PARTNER CO KRIS WORD
Other - Org Name:SUMMIT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-359-3800
Mailing Address - Street 1:2001 E HIGHWAY 114
Mailing Address - Street 2:SUITE 170
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6684
Mailing Address - Country:US
Mailing Address - Phone:817-359-3800
Mailing Address - Fax:
Practice Address - Street 1:2001 E HIGHWAY 114
Practice Address - Street 2:SUITE 170
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-6684
Practice Address - Country:US
Practice Address - Phone:817-359-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179721223G0001X
TX181711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty