Provider Demographics
NPI:1003812470
Name:BOURLAND, DRU BART (DDS)
Entity type:Individual
Prefix:DR
First Name:DRU
Middle Name:BART
Last Name:BOURLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 BUFFALO GAP RD
Mailing Address - Street 2:STE D1
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3364
Mailing Address - Country:US
Mailing Address - Phone:325-695-3300
Mailing Address - Fax:325-695-9899
Practice Address - Street 1:4601 BUFFALO GAP RD
Practice Address - Street 2:STE D1
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3364
Practice Address - Country:US
Practice Address - Phone:325-695-3300
Practice Address - Fax:325-695-9899
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXD186811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice