Provider Demographics
NPI:1306477542
Name:SGC DENTAL LLC
Entity type:Organization
Organization Name:SGC DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIXTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDUNO COGOLLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-223-5500
Mailing Address - Street 1:712 N HAMPTON RD STE 130
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 N HAMPTON RD STE 130
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4530
Practice Address - Country:US
Practice Address - Phone:972-223-5500
Practice Address - Fax:972-223-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty