| Sparkle Dental, Pllc | |
|
209 Elden St Ste 210 Herndon VA 20170-4846 | |
| (703) 376-8271 | |
| (703) 376-8383 |
| Full Name | Sparkle Dental, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 209 Elden St Ste 210, Herndon, Virginia |
| Authorized Official Name and Position | Ruth Kathleen Duchatellier-cange (DENTIST/OWNER) |
| Authorized Official Contact | 7033768271 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sparkle Dental, Pllc 209 Elden St Ste 210 Herndon VA 20170-4846 Ph: (703) 376-8271 | Sparkle Dental, Pllc 209 Elden St Ste 210 Herndon VA 20170-4846 Ph: (703) 376-8271 |
| NPI Number | 1760067011 |
|---|---|
| Provider Enumeration Date | 03/17/2021 |
| Last Update Date | 03/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760067011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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