Provider Demographics
NPI:1629502679
Name:KAMALJEET BRAR DDS PLLC
Entity Type:Organization
Organization Name:KAMALJEET BRAR DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMALJEET
Authorized Official - Middle Name:GURONE
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-285-2455
Mailing Address - Street 1:1121 FLOWER MOUND RD
Mailing Address - Street 2:STE 500
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3651
Mailing Address - Country:US
Mailing Address - Phone:214-285-2455
Mailing Address - Fax:214-285-2465
Practice Address - Street 1:1121 FLOWER MOUND RD
Practice Address - Street 2:STE 500
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3651
Practice Address - Country:US
Practice Address - Phone:214-285-2455
Practice Address - Fax:214-285-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457764953OtherNPI TYPE 1