Provider Demographics
NPI:1225479850
Name:SUGAR LAND DENTAL, PA
Entity Type:Organization
Organization Name:SUGAR LAND DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:LACROIX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-980-5100
Mailing Address - Street 1:101 SOUTHWESTERN BLVD., SUITE 204
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-980-5100
Mailing Address - Fax:281-980-5151
Practice Address - Street 1:101 SOUTHWESTERN BLVD., SUITE 204
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-980-5100
Practice Address - Fax:281-980-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198141223G0001X
TX11954124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty