MEDICARE: TEXAS ROOT CANAL SPECIALISTS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588309546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS ROOT CANAL SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	3131 GREEN MEADOW DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6977
Country	:	US
Telephone Number	:	325-939-2848
Fax Number	:	325-939-2249

Provider Business Practice Location Address
First Line	:	3131 GREEN MEADOW DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6977
Country	:	US
Telephone Number	:	325-939-2848
Fax Number	:	325-939-2249

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHAD BRANTLY
Credential	:	DDS
Telephone Number	:	325-949-9668

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/11/2022

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