Jerod Wilson Brazeal, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

27094 Issued in TX

Practice address

696 N Fielder Rd Ste 102
Arlington, TX 76012-3861

Phone

(817) 261-9772

NPI assigned

Jun 25, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fundentist-North

  • Pediatric Dentistry
  • Arlington, TX
  • NPI 1306953906
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1144516311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 BRYANT IRVIN RD STE 129",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761094212",
            "telephone_number": "817-731-6964",
            "fax_number": "817-731-4273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "696 N FIELDER RD STE 102",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760123861",
            "telephone_number": "817-261-9772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 Bryant Irvin Rd Ste 129",
            "address_purpose": "LOCATION",
            "city": "Benbrook",
            "state": "TX",
            "postal_code": "761094212",
            "country_code": "US",
            "telephone_number": "817-731-6964",
            "fax_number": "817-731-4273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAZEAL",
        "first_name": "JEROD",
        "middle_name": "WILSON",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-25",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "27094",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "27094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Alve Brashear-Briscoe, P.T.
• Bravo Dental
• Bravo Smiles
• Bravo Transport Services
• Jamiela Braxton
• Ashley Brazwell, MSN, RN, BSN
• Katherine Ann Breen, LCSW
• David Brefo
• Gary Bregman, PA
• Heather Jesstine Brehms, LMFT-A

• Pediatric Dentistry in Arlington, TX
• Providers in Arlington, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.