Provider Demographics
NPI:1912157371
Name:BILL, CRYSTAL LEE (DMD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:BILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEE
Other - Last Name:BORHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:706 E BELL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6641
Mailing Address - Country:US
Mailing Address - Phone:602-482-7000
Mailing Address - Fax:602-482-7021
Practice Address - Street 1:6849 N ORACLE RD STE 115
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4242
Practice Address - Country:US
Practice Address - Phone:520-696-0700
Practice Address - Fax:520-696-0705
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice