MEDICARE: WEST PARK DENTAL ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14689	TX

General Provider Information

NPI Number	:	1588715460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PARK DENTAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	4105 W SPRING CREEK PKWY
Second Line	:	SUITE 502
City	:	PLANO
State	:	TX
Zip	:	75024-5283
Country	:	US
Telephone Number	:	972-964-7500
Fax Number	:	972-596-6424

Provider Business Practice Location Address
First Line	:	4105 W SPRING CREEK PKWY
Second Line	:	SUITE 502
City	:	PLANO
State	:	TX
Zip	:	75024-5283
Country	:	US
Telephone Number	:	972-964-7500
Fax Number	:	972-596-6424

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES D. SANDRIDGE
Credential	:	D.D.S.
Telephone Number	:	972-964-7500

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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