Provider Demographics
NPI:1053066167
Name:WEST BRAZOS DENTAL CENTER BRAZORIA
Entity Type:Organization
Organization Name:WEST BRAZOS DENTAL CENTER BRAZORIA
Other - Org Name:WEST BRAZOS DENTAL CENTER BRAZORIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:YEAROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-345-1023
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-5005
Mailing Address - Country:US
Mailing Address - Phone:979-798-9103
Mailing Address - Fax:979-798-9109
Practice Address - Street 1:324 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:BRAZORIA
Practice Address - State:TX
Practice Address - Zip Code:77422-8718
Practice Address - Country:US
Practice Address - Phone:979-248-4248
Practice Address - Fax:979-798-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No122300000XDental ProvidersDentistGroup - Single Specialty