Provider Demographics
NPI:1598025843
Name:SA DENTAL OF ALLEN
Entity Type:Organization
Organization Name:SA DENTAL OF ALLEN
Other - Org Name:IDEAL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SULMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-697-8732
Mailing Address - Street 1:190 E STACY RD
Mailing Address - Street 2:SUITE 1618
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:190 E STACY RD
Practice Address - Street 2:SUITE 1618
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8734
Practice Address - Country:US
Practice Address - Phone:940-321-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty