Healthcare Provider Details

I. General information

NPI: 1023703758
Provider Name (Legal Business Name): SPARROW DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 PROFESSIONAL PARK DR
CONWAY SC
29526-9260
US

IV. Provider business mailing address

144 PROFESSIONAL PARK DR
CONWAY SC
29526-9260
US

V. Phone/Fax

Practice location:
  • Phone: 843-349-8888
  • Fax:
Mailing address:
  • Phone: 843-349-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LU CAO DINH
Title or Position: OWNER
Credential: DMD
Phone: 214-991-9913