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NPI Code Detail

MEDICARE: CITRUS-04 PLLC

MEDICARE: CITRUS-04 PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1104636117
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITRUS-04 PLLC
Provider Business Mailing Address
First Line : 2650 W LUCAS RD # 120
Second Line :
City : LUCAS
State : TX
Zip : 75002-7513
Country : US
Telephone Number : 214-785-8271
Fax Number :
Provider Business Practice Location Address
First Line : 2650 W LUCAS RD # 120
Second Line :
City : LUCAS
State : TX
Zip : 75002-7513
Country : US
Telephone Number : 214-785-8271
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. GURSIMRAN AURORA
Credential :
Telephone Number : 339-234-3232
Provider Enumeration Date : 01/10/2025
Last Update Date : 01/10/2025

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Directions to “CITRUS-04 PLLC ” Practice Location

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