Provider Demographics
NPI:1821227885
Name:FLUELLEN, BRIANNA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:LYNN
Last Name:FLUELLEN
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 1:701 N CENTRAL EXPY BLDG 4
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5358
Mailing Address - Country:US
Mailing Address - Phone:972-231-8241
Mailing Address - Fax:972-231-8261
Practice Address - Street 1:701 N CENTRAL EXPY BLDG 4
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5358
Practice Address - Country:US
Practice Address - Phone:972-231-8241
Practice Address - Fax:972-231-8261
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice