Provider Demographics
NPI:1437327467
Name:BLUEBONNET DENTAL, P.A.
Entity Type:Organization
Organization Name:BLUEBONNET DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-242-5890
Mailing Address - Street 1:2150 N JOSEY LN
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2991
Mailing Address - Country:US
Mailing Address - Phone:972-242-5890
Mailing Address - Fax:972-242-5906
Practice Address - Street 1:2150 N JOSEY LN
Practice Address - Street 2:SUITE 306
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2991
Practice Address - Country:US
Practice Address - Phone:972-242-5890
Practice Address - Fax:972-242-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty