Provider Demographics
NPI:1497001002
Name:DUBLIN FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:DUBLIN FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-445-2442
Mailing Address - Street 1:117 N GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-1907
Mailing Address - Country:US
Mailing Address - Phone:254-445-2442
Mailing Address - Fax:254-445-4779
Practice Address - Street 1:117 N GRAFTON ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446-1907
Practice Address - Country:US
Practice Address - Phone:254-445-2442
Practice Address - Fax:254-445-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217305601Medicaid