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General NPI Number Information
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NPI Number | 1295162345
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Entity Type | Organization
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Legal Business Name | ACD PROFESSIONAL
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 2700 BARTON CREEK BLVD STE 100
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City | AUSTIN
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State | TX
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Zip | 78735-1641
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Country | US
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Telephone | 512-382-5888
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Fax | 512-382-5826
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Provider Business Mailing Address
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Address Line | 1127 S MAIN ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-7533
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Country | US
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Telephone | 817-380-5936
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Fax | 817-442-0900
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Authorized Official
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Title or Position | DENTIST
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Name | JARED BRUGGEMAN
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Credential | DDS
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Telephone | 817-912-2982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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