MEDICARE: ARLINGTON GROUP DENTAL PLLC.

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		TX

General Provider Information

NPI Number	:	1336542281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARLINGTON GROUP DENTAL PLLC.

Provider Business Mailing Address
First Line	:	939 EAST PARK ROW DR.
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-4508
Country	:	US
Telephone Number	:	817-987-1293
Fax Number	:	817-987-1297

Provider Business Practice Location Address
First Line	:	939 EAST PARK ROW DR.
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-4508
Country	:	US
Telephone Number	:	817-987-1293
Fax Number	:	817-987-1297

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NGOCDIEP N. SUDBROOK
Credential	:	DDS
Telephone Number	:	817-987-1293

Provider Enumeration Date	:	10/07/2014
Last Update Date	:	10/07/2014

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