Provider Demographics
NPI:1285110528
Name:TRAEGER, CRYSTAL MAY (DMD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MAY
Last Name:TRAEGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 PAUL JONES PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2924
Mailing Address - Country:US
Mailing Address - Phone:512-986-3325
Mailing Address - Fax:
Practice Address - Street 1:3909 N IH 35 STE A1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1529
Practice Address - Country:US
Practice Address - Phone:512-458-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7114122300000X
TX353711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist