Provider Demographics
NPI:1164934543
Name:IBRITE DENTAL - CLEBURNE, PLLC
Entity Type:Organization
Organization Name:IBRITE DENTAL - CLEBURNE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-793-0013
Mailing Address - Street 1:2104 CASTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5330
Mailing Address - Country:US
Mailing Address - Phone:817-368-6378
Mailing Address - Fax:888-600-6547
Practice Address - Street 1:1301 W HENDERSON ST STE H
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5117
Practice Address - Country:US
Practice Address - Phone:817-641-3344
Practice Address - Fax:817-641-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21298261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental