Organization
SPARKLE DENTAL CENTER
Active
Other names
Life Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TUAN NGUYEN (PRESIDENT)
(214) 780-0600
Entity
Organization
Contact information
Practice address
3330 DOUGLAS AVE, DALLAS, TX 75219-2717
(214) 780-0600
Mailing address
3330 DOUGLAS AVE STE B, DALLAS, TX 75219-2717
(214) 780-0600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
21736
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176281701
—
TX
Enumeration date
02/17/2007
Last updated
01/06/2022
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