Provider Demographics
NPI:1487724563
Name:TIMOTHY E. CRONIN, DDS, INC.
Entity type:Organization
Organization Name:TIMOTHY E. CRONIN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-943-8824
Mailing Address - Street 1:400 S ZANG BLVD STE 820
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6643
Mailing Address - Country:US
Mailing Address - Phone:214-943-8824
Mailing Address - Fax:214-943-4057
Practice Address - Street 1:400 S ZANG BLVD STE 820
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6643
Practice Address - Country:US
Practice Address - Phone:214-943-8824
Practice Address - Fax:214-943-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0081259-01Medicaid