Provider Demographics
NPI:1215685227
Name:LEGACY DENTAL OF GRAND PRAIRIE PLLC
Entity type:Organization
Organization Name:LEGACY DENTAL OF GRAND PRAIRIE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-444-9958
Mailing Address - Street 1:902 W PIONEER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4737
Mailing Address - Country:US
Mailing Address - Phone:214-444-9958
Mailing Address - Fax:214-444-9959
Practice Address - Street 1:902 W PIONEER PKWY # 200
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4737
Practice Address - Country:US
Practice Address - Phone:214-444-9958
Practice Address - Fax:214-444-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty