Provider Demographics
NPI:1952032617
Name:TEXAS DENTAL SPA PLLC
Entity Type:Organization
Organization Name:TEXAS DENTAL SPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINH
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-242-2155
Mailing Address - Street 1:1809 GOLDEN TRAIL CT STE 140
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4667
Mailing Address - Country:US
Mailing Address - Phone:972-242-2155
Mailing Address - Fax:
Practice Address - Street 1:2995 PRESTON RD STE 1500
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0602
Practice Address - Country:US
Practice Address - Phone:972-242-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental