Healthcare Provider Details

I. General information

NPI: 1598810558
Provider Name (Legal Business Name): BART BOURLAND D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 BUFFALO GAP RD STE. D-1
ABILENE TX
79606-3375
US

IV. Provider business mailing address

4601 BUFFALO GAP RD STE. D-1
ABILENE TX
79606-3375
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-3300
  • Fax: 325-695-9899
Mailing address:
  • Phone: 325-695-3300
  • Fax: 325-695-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18681
License Number StateTX

VIII. Authorized Official

Name: DR. DRU BART BOURLAND
Title or Position: OWNER
Credential: D.D.S.
Phone: 325-695-3300