Healthcare Provider Details

I. General information

NPI: 1396464111
Provider Name (Legal Business Name): BRIAN SON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 W WALNUT ST STE A
GARLAND TX
75042-4108
US

IV. Provider business mailing address

2370 VICTORY AVE APT 1206
DALLAS TX
75219-7918
US

V. Phone/Fax

Practice location:
  • Phone: 214-466-1400
  • Fax: 214-367-5896
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38935
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: