Provider Demographics
NPI:1760067011
Name:SPARKLE DENTAL, PLLC
Entity Type:Organization
Organization Name:SPARKLE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:DUCHATELLIER-CANGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-376-8271
Mailing Address - Street 1:209 ELDEN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4846
Mailing Address - Country:US
Mailing Address - Phone:703-376-8271
Mailing Address - Fax:703-376-8383
Practice Address - Street 1:209 ELDEN ST STE 210
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4846
Practice Address - Country:US
Practice Address - Phone:703-376-8271
Practice Address - Fax:703-376-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental