Provider Demographics
NPI:1669824611
Name:SURA, BRENNA (DDS)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:SURA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 VISTA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3218
Mailing Address - Country:US
Mailing Address - Phone:512-689-5672
Mailing Address - Fax:
Practice Address - Street 1:4405 WILLIAMS DR STE 300
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1391
Practice Address - Country:US
Practice Address - Phone:512-686-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist