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1615 Barak Ln Ste 6 Bryan TX 77802-3301 | |
| (979) 846-2500 | |
| (979) 260-9390 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1615 Barak Ln Ste 6, Bryan, Texas |
| Authorized Official Name and Position | Theresa Sabella (CEO) |
| Authorized Official Contact | 9793832348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1500 University Dr E Ste 100 College Station TX 77840-2600 Ph: (979) 383-2340 | 1615 Barak Ln Ste 6 Bryan TX 77802-3301 Ph: (979) 846-2500 |
| NPI Number | 1184192064 |
|---|---|
| Provider Enumeration Date | 11/08/2018 |
| Last Update Date | 07/10/2024 |
| Medicare PECOS PAC ID | 4284542127 |
|---|---|
| Medicare Enrollment ID | O20240829003392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184192064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Gordon Pratt Jr Dds Ms Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2011c E Villa Maria, Bryan, TX 77802 Phone: 979-776-8689 Fax: 979-776-1335 | |
John H. Case D.d.s., M.s., P.l.l.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1326 Memorial Dr, Bryan, TX 77802 Phone: 979-776-8100 Fax: 979-776-8123 | |
Brian Barras, Dds, Ms, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1326 Memorial Dr, Bryan, TX 77802 Phone: 979-776-8100 Fax: 979-776-8123 | |
J. Craig Scasta, D.d.s., Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1615 Barak Ln Ste 2, Bryan, TX 77802 Phone: 979-260-2626 Fax: 979-260-2631 | |