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General NPI Number Information
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NPI Number | 1538502786
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Entity Type | Organization
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Legal Business Name | LEGACY DENTAL OF EAST DALLAS, PLLC
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 04/08/2013
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Provider Practice Location Address
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Address Line | 4201 GASTON AVE SUITE102
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City | DALLAS
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State | TX
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Zip | 75246-1400
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Country | US
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Telephone | 214-370-8383
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Fax | 214-370-8384
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Provider Business Mailing Address
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Address Line | 4201 GASTON AVE SUITE102
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City | DALLAS
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State | TX
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Zip | 75246-1400
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Country | US
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Telephone | 214-370-8383
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Fax | 214-370-8384
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SOHAIL DAR
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Credential | DDS
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Telephone | 832-725-9895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25393
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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 | 25391
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License Number State | TX
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