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Organization

SPROUT DENTISTRY FOR KIDS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SAGE S YOO DMD (PEDIATRIC DENTIST/PARTNER)
(469) 301-3212
Entity
Organization

Contact information

Practice address
6675 S. CUSTER RD, MCKINNEY, TX 75070
(469) 301-3212
(469) 301-3213
Mailing address
585 CHARDONNAY DR, FAIRVIEW, TX 75069-1542
(469) 301-3212

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1223P0221X
Pediatric Dentistry
Primary
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1144508292
MEDICAID - DENTALQUEST
TX
01
27280
MEDICAID - MCNA
TX
01
2986143-06
MEDICAID - TMHP
TX
01
32386
MEDICAID - MCNA
TX
Enumeration date
04/16/2019
Last updated
04/30/2019
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