| Jerod Brazeal, Dds, Pllc | |
|
4200 Bryant Irvin Rd Ste 129 Benbrook TX 76109-4212 | |
| (817) 731-6964 | |
| (817) 731-4273 |
| Full Name | Jerod Brazeal, Dds, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4200 Bryant Irvin Rd Ste 129, Benbrook, Texas |
| Authorized Official Name and Position | Jerod Brazeal (OWNER) |
| Authorized Official Contact | 8177316964 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jerod Brazeal, Dds, Pllc 4200 Bryant Irvin Rd Ste 129 Benbrook TX 76109-4212 Ph: (817) 731-6964 | Jerod Brazeal, Dds, Pllc 4200 Bryant Irvin Rd Ste 129 Benbrook TX 76109-4212 Ph: (817) 731-6964 |
| NPI Number | 1538660949 |
|---|---|
| Provider Enumeration Date | 02/22/2018 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538660949 | NPI | - | NPPES |
| 2835811 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 27094 (Texas) | Primary |
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