Crestway Park Dental, P.a.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22191 Issued in TX

Legal business name

CRESTWAY PARK DENTAL, P.A.

Doing business as

Allen Family Dentistry

Practice address

208 Crestway St
Athens, TX 75751

Phone

(903) 675-3811

Fax

(903) 675-2800

NPI assigned

Jul 23, 2008

Last updated

Apr 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hannah Lively

Title

Business Manager

Phone

(903) 675-3811

Specialties & licenses 1

Addresses

Other names 1

• Allen Family Dentistry Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• J. Brandon Allen, D.D.S.

  • General Practice Dentistry
  • Athens, TX
  • NPI 1730191859
  NPD
• Devin Danielle Tompkins, DDS

  • Dentist
  • Athens, TX
  • NPI 1548903297
  NPD
• Meagan Nicole Fancher, DDS

  • Dentist
  • Jacksonville, TX
  • NPI 1649653460

  General Practice

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1508021114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 CRESTWAY ST",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "75751",
            "telephone_number": "903-675-3811",
            "fax_number": "903-675-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 CRESTWAY ST",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "75751",
            "telephone_number": "903-675-3811",
            "fax_number": "903-675-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWAY PARK DENTAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-23",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "LIVELY",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "903-675-3811"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allen Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amber N Cook, MD
• Shecarra Cook
• Coryell County Memorial Hospital Authority (Advanced Rehabilitation and Healthcare of Athens)
• Marjorie Ellen Cox, CSFA
• Micah U Craig
• Thomas John Crigler, APRN
• Veronnica Antonette Crowder, RPH
• Michelle Ruth Crye, LPC
• CSL 2015 Athens LLC (Arabella of Athens)
• Cheyenne Culberson, PTA

• General Practice Dentistry in Athens, TX
• Providers in Athens, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.