Provider Demographics
NPI:1336463934
Name:AMANDEEP BASRAI PA
Entity Type:Organization
Organization Name:AMANDEEP BASRAI PA
Other - Org Name:FAMILY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENITIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BASRAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-426-9337
Mailing Address - Street 1:225 EXCHANGE ST
Mailing Address - Street 2:STE. D
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 N HIGHWAY 77
Practice Address - Street 2:STE. 104
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1399
Practice Address - Country:US
Practice Address - Phone:817-426-9337
Practice Address - Fax:817-426-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty