Healthcare Provider Details

I. General information

NPI: 1659707933
Provider Name (Legal Business Name): BRACKETS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SHEPHERD LANE
BALCH SPRINGS TX
75180
US

IV. Provider business mailing address

15110 DALLAS PARKWAY SUITE 470
DALLAS TX TX
75248
US

V. Phone/Fax

Practice location:
  • Phone: 972-512-0285
  • Fax: 972-239-0755
Mailing address:
  • Phone: 972-286-5711
  • Fax: 972-557-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SARABJIT KHASSA
Title or Position: MANAGER
Credential:
Phone: 972-512-0285