Spa Dental

Primary specialty

DentistTaxonomy code 122300000X

License

16975 Issued in TX

Legal business name

SPA DENTAL

Practice address

5435 North Garland Ave 125
Garland, TX 75034

Phone

(972) 530-7374

Fax

(972) 530-7636

NPI assigned

Nov 22, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan M Koo, DDS

Title

Dentist

Phone

(972) 530-7374

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174698260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5435 NORTH GARLAND AVE 125",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "75034",
            "telephone_number": "972-530-7374",
            "fax_number": "972-530-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5435 NORTH GARLAND AVE 125",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "75034",
            "telephone_number": "972-530-7374",
            "fax_number": "972-530-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOO",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "972-530-7374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "16975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South First Dental ,PC
• South Garland Medical PLLC
• South Medical Supply and Equipment LLC
• South Texas Dental Associates, LP
• Southwest Family Dentistry & Orthodontics PLLC
• Lacie Spain, OT
• Sparkle Dental Center
• Sparkle Dentistry Garland PLLC
• Sparkle Orthodontics
• Luanne Sparks, ED.D.

• Dentist in Garland, TX
• Providers in Garland, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.