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General NPI Number Information
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NPI Number | 1225479850
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Entity Type | Organization
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Legal Business Name | SUGAR LAND DENTAL, PA
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 101 SOUTHWESTERN BLVD., SUITE 204
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City | SUGAR LAND
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State | TX
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Zip | 77478
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Country | US
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Telephone | 281-980-5100
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Fax | 281-980-5151
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Provider Business Mailing Address
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Address Line | 101 SOUTHWESTERN BLVD., SUITE 204
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City | SUGAR LAND
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State | TX
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Zip | 77478
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Country | US
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Telephone | 281-980-5100
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Fax | 281-980-5151
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURA SPENCER LACROIX
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Credential | DDS
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Telephone | 281-980-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 11954
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19814
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License Number State | TX
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