Provider Demographics
NPI:1538502786
Name:LEGACY DENTAL OF EAST DALLAS, PLLC
Entity Type:Organization
Organization Name:LEGACY DENTAL OF EAST DALLAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-725-9895
Mailing Address - Street 1:4201 GASTON AVE
Mailing Address - Street 2:SUITE102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1400
Mailing Address - Country:US
Mailing Address - Phone:214-370-8383
Mailing Address - Fax:214-370-8384
Practice Address - Street 1:4201 GASTON AVE
Practice Address - Street 2:SUITE102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1400
Practice Address - Country:US
Practice Address - Phone:214-370-8383
Practice Address - Fax:214-370-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253911223G0001X
TX253931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty