Jerod Brazeal, DDS, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

27094 Issued in TX

Legal business name

JEROD BRAZEAL, DDS, PLLC

Practice address

4200 Bryant Irvin Rd Ste 129
Benbrook, TX 76109-4212

Phone

(817) 731-6964

Fax

(817) 731-4273

NPI assigned

Feb 22, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jerod Brazeal, DDS

Title

Owner

Phone

(817) 731-6964

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1538660949",
    "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": "4200 BRYANT IRVIN RD STE 129",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761094212",
            "telephone_number": "817-731-6964",
            "fax_number": "817-731-4273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROD BRAZEAL, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-22",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "BRAZEAL",
        "authorized_official_first_name": "JEROD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-731-6964",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "27094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2835811",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alycia Jackson
• Kayla Jackson
• Mark Wayne Jackson
• Samuel Jampolis, M.D.
• Jennifer Heath MD
• Sarina Jimenez
• Ernest Johnson
• Madeline Johnson
• Samantha Ashley Johnson, DPT
• Shaun Johnson

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.