Provider Demographics
NPI:1922546431
Name:ALLY DENTAL OF FLORESVILLE PLLC
Entity Type:Organization
Organization Name:ALLY DENTAL OF FLORESVILLE PLLC
Other - Org Name:FLORESVILLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPARACINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-741-6721
Mailing Address - Street 1:121 W HICKORY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4190
Mailing Address - Country:US
Mailing Address - Phone:214-741-6721
Mailing Address - Fax:940-220-4451
Practice Address - Street 1:534 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3199
Practice Address - Country:US
Practice Address - Phone:214-741-6721
Practice Address - Fax:940-220-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty