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General NPI Number Information
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NPI Number | 1942587209
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Entity Type | Organization
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Legal Business Name | ANNA BLUEBONNET DENTAL PLLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 804 S CENTRAL EXPY SUITE 201
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City | ANNA
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State | TX
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Zip | 75409-4512
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Country | US
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Telephone | 214-872-2391
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Fax |
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Provider Business Mailing Address
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Address Line | 11795 MORDOR LN
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City | FRISCO
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State | TX
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Zip | 75035-6931
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Country | US
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Telephone | 214-872-2391
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL/OWNER
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Name | SEEMA BHAKTA
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Credential | DDS
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Telephone | 214-872-2391
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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 | 23860
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License Number State | TX
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