Provider Demographics
NPI:1215483771
Name:SUGARLAND MINT DENTISTRY PLLC
Entity type:Organization
Organization Name:SUGARLAND MINT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SGRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-939-0853
Mailing Address - Street 1:13134 DAIRY ASHFORD RD
Mailing Address - Street 2:#200
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3756
Mailing Address - Country:US
Mailing Address - Phone:713-692-6468
Mailing Address - Fax:
Practice Address - Street 1:13134 DAIRY ASHFORD RD
Practice Address - Street 2:#200
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3756
Practice Address - Country:US
Practice Address - Phone:713-692-6468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental