Provider Demographics
NPI:1104581412
Name:BROWNWOOD TX DENTAL PLLC
Entity type:Organization
Organization Name:BROWNWOOD TX DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMALPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:325-643-2551
Mailing Address - Street 1:13551 SPOKANE WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1334
Mailing Address - Country:US
Mailing Address - Phone:347-759-2152
Mailing Address - Fax:
Practice Address - Street 1:1001 AVENUE K
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-4531
Practice Address - Country:US
Practice Address - Phone:325-643-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental