Provider Demographics
NPI:1891312419
Name:CRASTO, GAZELLE JEAN (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:GAZELLE
Middle Name:JEAN
Last Name:CRASTO
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W 57TH ST APT 2517
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1957
Mailing Address - Country:US
Mailing Address - Phone:929-360-6191
Mailing Address - Fax:
Practice Address - Street 1:ASPEN DENTAL
Practice Address - Street 2:2320 S 31ST ST STE 120
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-534-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064187-011223P0300X
TX36343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist