Provider Demographics
NPI:1588801633
Name:PURE DENTAL, P.A.
Entity Type:Organization
Organization Name:PURE DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRODY
Authorized Official - Middle Name:JAMISON
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-824-7873
Mailing Address - Street 1:8411 PRESTON RD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5523
Mailing Address - Country:US
Mailing Address - Phone:214-824-7873
Mailing Address - Fax:
Practice Address - Street 1:5321 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5185
Practice Address - Country:US
Practice Address - Phone:214-824-7873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty