Healthcare Provider Details

I. General information

NPI: 1396065520
Provider Name (Legal Business Name): BRANDI BURGAN HARRIS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N GRAFTON ST
DUBLIN TX
76446-1907
US

IV. Provider business mailing address

117 N GRAFTON ST
DUBLIN TX
76446-1907
US

V. Phone/Fax

Practice location:
  • Phone: 254-445-2442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: