Provider Demographics
NPI:1942587209
Name:ANNA BLUEBONNET DENTAL PLLC
Entity Type:Organization
Organization Name:ANNA BLUEBONNET DENTAL PLLC
Other - Org Name:BLUEBONNET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-872-2391
Mailing Address - Street 1:11795 MORDOR LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6931
Mailing Address - Country:US
Mailing Address - Phone:214-872-2391
Mailing Address - Fax:
Practice Address - Street 1:804 S CENTRAL EXPY
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-4512
Practice Address - Country:US
Practice Address - Phone:214-872-2391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty