Provider Demographics
NPI:1093126039
Name:BRACKETS DENTAL PLLC
Entity Type:Organization
Organization Name:BRACKETS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURROLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-512-0285
Mailing Address - Street 1:15110 DALLAS PKWY
Mailing Address - Street 2:470
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 S HAMPTON RD
Practice Address - Street 2:201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2367
Practice Address - Country:US
Practice Address - Phone:469-608-8327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty