Healthcare Provider Details

I. General information

NPI: 1750818159
Provider Name (Legal Business Name): USPARKLE DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 DAIRY ASHFORD RD
HOUSTON TX
77079-4602
US

IV. Provider business mailing address

1013 DAIRY ASHFORD RD
HOUSTON TX
77079-4602
US

V. Phone/Fax

Practice location:
  • Phone: 832-781-0462
  • Fax: 832-770-9366
Mailing address:
  • Phone: 832-781-0462
  • Fax: 832-770-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number23488
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMILA HUSAIN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 832-781-0462