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
—
—
Other
Enumeration date
03/26/2013
Last updated
04/01/2013
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