MEDICARE: SALES FAMILY DENTAL, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20745	TX

General Provider Information

NPI Number	:	1164701462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALES FAMILY DENTAL, PA

Provider Business Mailing Address
First Line	:	1735 KELLER SPRINGS RD
Second Line	:	SUITE 212
City	:	CARROLLTON
State	:	TX
Zip	:	75006-2962
Country	:	US
Telephone Number	:	972-245-4886
Fax Number	:	972-245-4977

Provider Business Practice Location Address
First Line	:	1735 KELLER SPRINGS RD
Second Line	:	SUITE 212
City	:	CARROLLTON
State	:	TX
Zip	:	75006-2962
Country	:	US
Telephone Number	:	972-245-4886
Fax Number	:	972-245-4977

Authorized Official
Title or Position	:	DOCTOR
Name	:	MRS. REGAN SALES
Credential	:	DDS
Telephone Number	:	972-245-4886

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	08/04/2011

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