| Organization Name: | TEXAS GRINS FAMILY DENTISTRY, PA |
| NPI Number: | 1619252293 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER RYAN CRAIN (OWNER) |
| Mailing Address: | 136 El Chico Trl Suite 101 Willow Park |
| State: | TX US |
| Postal Code: | 760878863 |
| Phone Number: | 8174413232 |
| Fax Number: | 8174412230 |
| NPI Enumeration Date: | 10/14/2011 |
| NPI Last Update Date: | 10/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 22460 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |