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Organization
DENTAL PROVIDER RESOURCES 5, PLLC
Active
Organization
DENTAL PROVIDER RESOURCES 5, PLLC
Active
Other names
Waterway Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED BRUGGEMAN DDS (OWNER/DOCTOR)
(817) 328-6153
Entity
Organization
Contact information
Practice address
26219 INTERSTATE 45, THE WOODLANDS, TX 77380-1903
(817) 328-6150
Mailing address
1000 TEXAN TRL, STE 229, GRAPEVINE, TX 76051-3776
(817) 328-6150
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
NULL
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Enumeration date
03/26/2013
Last updated
04/01/2013
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