# SPARKLE DENTAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760067011
- **Authorized official:** DR. RUTH KATHLEEN DUCHATELLIER-CANGE DDS (DENTIST/OWNER)
- **Authorized official phone:** (703) 376-8271

## Contact information

- **Practice address:** 209 ELDEN ST STE 210, HERNDON, VA 20170-4846
- **Practice address phone:** (703) 376-8271
- **Practice address fax:** (703) 376-8383
- **Mailing address:** 209 ELDEN ST STE 210, HERNDON, VA 20170-4846
- **Mailing address phone:** (703) 376-8271
- **Mailing address fax:** (703) 376-8383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/17/2021
- **Last updated:** 03/17/2021