Healthcare Provider Details

I. General information

NPI: 1487978045
Provider Name (Legal Business Name): LHCB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 FORT WORTH HWY SUITE 300
WEATHERFORD TX
76086-4627
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 325-660-3313
  • Fax: 325-695-9899
Mailing address:
  • Phone: 325-660-3313
  • Fax: 325-695-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18681
License Number StateTX

VIII. Authorized Official

Name: DR. DRU BART BOURLAND
Title or Position: OWNER/MANAGING PARTNER
Credential: DDS
Phone: 325-660-3313