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General NPI Number Information
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NPI Number | 1700962982
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Entity Type | Organization
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Legal Business Name | TROPHY DENTAL OF PLANO, P.A.
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 1101 JUPITER ROAD
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City | PLANO
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State | TX
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Zip | 75074
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Country | US
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Telephone | 972-422-5020
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Fax | 972-578-6049
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Provider Business Mailing Address
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Address Line | 1101 JUPITER ROAD
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City | PLANO
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State | TX
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Zip | 75074
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Country | US
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Telephone | 972-422-5020
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Fax | 972-578-6049
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Authorized Official
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Title or Position | OWNER
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Name | NGOCDIEP (DEBBIE) NGUYEN SUDBROOK
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Credential | DDS
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Telephone | 972-422-5020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18139
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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 | 18141
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License Number State | TX
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