Provider Demographics
NPI:1700962982
Name:TROPHY DENTAL OF PLANO, P.A.
Entity Type:Organization
Organization Name:TROPHY DENTAL OF PLANO, P.A.
Other - Org Name:TROPHY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGOCDIEP (DEBBIE)
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:SUDBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-422-5020
Mailing Address - Street 1:1101 JUPITER ROAD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:972-422-5020
Mailing Address - Fax:972-578-6049
Practice Address - Street 1:1101 JUPITER ROAD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:972-422-5020
Practice Address - Fax:972-578-6049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18139122300000X
TX181411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty