Provider Demographics
NPI:1295904142
Name:IN SPA DENTISTRY, PLLC
Entity type:Organization
Organization Name:IN SPA DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NHI
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-668-0412
Mailing Address - Street 1:8700 PRESTON RD STE 126
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3321
Mailing Address - Country:US
Mailing Address - Phone:972-668-0142
Mailing Address - Fax:972-668-0143
Practice Address - Street 1:8700 PRESTON RD STE 126
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3321
Practice Address - Country:US
Practice Address - Phone:972-668-0142
Practice Address - Fax:972-668-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1609096858Medicaid