Provider Demographics
NPI:1609017052
Name:SPARKLE DENTAL CENTER ASSOCIATES PC
Entity Type:Organization
Organization Name:SPARKLE DENTAL CENTER ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-360-8036
Mailing Address - Street 1:9205 SKILLMAN ST
Mailing Address - Street 2:STE 128
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9031
Mailing Address - Country:US
Mailing Address - Phone:469-360-8036
Mailing Address - Fax:972-840-6830
Practice Address - Street 1:9205 SKILLMAN ST
Practice Address - Street 2:STE 128
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9031
Practice Address - Country:US
Practice Address - Phone:469-360-8036
Practice Address - Fax:972-840-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty