Provider Demographics
NPI:1124344452
Name:SPARKLE DENTAL CENTER AT FERGUSON PC
Entity type:Organization
Organization Name:SPARKLE DENTAL CENTER AT FERGUSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-342-9600
Mailing Address - Street 1:9205 SKILLMAN ST
Mailing Address - Street 2:STE 128
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9031
Mailing Address - Country:US
Mailing Address - Phone:214-342-9600
Mailing Address - Fax:214-342-9604
Practice Address - Street 1:2572 GUS THOMASSON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3017
Practice Address - Country:US
Practice Address - Phone:214-342-9600
Practice Address - Fax:214-342-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty