Provider Demographics
NPI:1124446448
Name:SMILE RANCH FAMILY DENTISTRY
Entity type:Organization
Organization Name:SMILE RANCH FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ROBYN
Authorized Official - Last Name:ABRAMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-772-7645
Mailing Address - Street 1:6700 HORIZON RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2058
Mailing Address - Country:US
Mailing Address - Phone:972-772-7645
Mailing Address - Fax:469-402-2003
Practice Address - Street 1:6700 HORIZON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2058
Practice Address - Country:US
Practice Address - Phone:972-772-7645
Practice Address - Fax:469-402-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty