Provider Demographics
NPI:1427335223
Name:CRYSTAL FALLS DENTAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:CRYSTAL FALLS DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LOFTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-260-7400
Mailing Address - Street 1:500 CRYSTAL FALLS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-260-7400
Mailing Address - Fax:512-260-7409
Practice Address - Street 1:500 CRYSTAL FALLS PARKWAY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1921
Practice Address - Country:US
Practice Address - Phone:512-260-7400
Practice Address - Fax:512-260-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty