Provider Demographics
NPI:1023600418
Name:IBRUSH FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:IBRUSH FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-800-3513
Mailing Address - Street 1:3513 MCCART AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4600
Mailing Address - Country:US
Mailing Address - Phone:817-921-4646
Mailing Address - Fax:817-921-4546
Practice Address - Street 1:3513 MCCART AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4600
Practice Address - Country:US
Practice Address - Phone:817-921-4646
Practice Address - Fax:817-921-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty