Provider Demographics
NPI:1811445000
Name:SANGER DENTAL PLLC
Entity type:Organization
Organization Name:SANGER DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:K
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-522-4457
Mailing Address - Street 1:617 N 10TH ST
Mailing Address - Street 2:204/205
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-4240
Mailing Address - Country:US
Mailing Address - Phone:708-522-4457
Mailing Address - Fax:
Practice Address - Street 1:617 N 10TH ST
Practice Address - Street 2:204/205
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-4240
Practice Address - Country:US
Practice Address - Phone:708-522-4457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty