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General NPI Number Information
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NPI Number | 1053066167
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Entity Type | Organization
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Legal Business Name | WEST BRAZOS DENTAL CENTER BRAZORIA
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 324 N BROOKS ST
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City | BRAZORIA
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State | TX
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Zip | 77422-8718
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Country | US
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Telephone | 979-248-4248
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Fax | 979-798-9109
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Provider Business Mailing Address
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Address Line | PO BOX 5005
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City | BRAZORIA
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State | TX
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Zip | 77422-5005
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Country | US
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Telephone | 979-798-9103
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Fax | 979-798-9109
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM R YEAROUT
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Credential |
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Telephone | 979-345-1023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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