Provider Demographics
NPI:1366688749
Name:BOURLAND SOBEN PLLC
Entity Type:Organization
Organization Name:BOURLAND SOBEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-695-3300
Mailing Address - Street 1:4601 BUFFALO GAP RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3375
Mailing Address - Country:US
Mailing Address - Phone:325-695-3300
Mailing Address - Fax:325-695-9899
Practice Address - Street 1:4601 BUFFALO GAP RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3375
Practice Address - Country:US
Practice Address - Phone:325-695-3300
Practice Address - Fax:325-695-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18681261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental