Provider Demographics
NPI:1932662756
Name:LEGACY DENTAL OF DESOTO PLLC
Entity Type:Organization
Organization Name:LEGACY DENTAL OF DESOTO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-747-2001
Mailing Address - Street 1:834 N HAMPTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4504
Mailing Address - Country:US
Mailing Address - Phone:469-747-2001
Mailing Address - Fax:
Practice Address - Street 1:834 N HAMPTON RD # 102
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4512
Practice Address - Country:US
Practice Address - Phone:832-725-9895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty