Provider Demographics
NPI:1093281289
Name:BRUSH32 DENTAL OF SOUTH CONGRESS PLLC
Entity Type:Organization
Organization Name:BRUSH32 DENTAL OF SOUTH CONGRESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SULMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-361-0600
Mailing Address - Street 1:PO BOX 840925
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8900 S CONGRESS AVE
Practice Address - Street 2:STE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7393
Practice Address - Country:US
Practice Address - Phone:512-337-8223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty