Provider Demographics
NPI:1497189435
Name:DATTA, LLC
Entity Type:Organization
Organization Name:DATTA, LLC
Other - Org Name:SONRISA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INDRAJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-282-9100
Mailing Address - Street 1:1625 S BELT LINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3309
Mailing Address - Country:US
Mailing Address - Phone:972-282-9100
Mailing Address - Fax:214-295-9782
Practice Address - Street 1:1625 S BELT LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3309
Practice Address - Country:US
Practice Address - Phone:972-282-9100
Practice Address - Fax:214-295-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty