Organization
JEROD BRAZEAL, DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROD BRAZEAL DDS (OWNER)
(817) 731-6964
Entity
Organization
Contact information
Practice address
4200 BRYANT IRVIN RD STE 129, BENBROOK, TX 76109-4212
(817) 731-6964
(817) 731-4273
Mailing address
4200 BRYANT IRVIN RD STE 129, BENBROOK, TX 76109-4212
(817) 731-6964
(817) 731-4273
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
27094
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2835811
—
TX
Enumeration date
02/22/2018
Last updated
06/16/2018
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