Provider Demographics
NPI:1730595612
Name:SPK FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:SPK FAMILY DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KODALI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-546-3888
Mailing Address - Street 1:355 E WESTCHESTER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2846
Mailing Address - Country:US
Mailing Address - Phone:972-546-3888
Mailing Address - Fax:
Practice Address - Street 1:355 E WESTCHESTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2846
Practice Address - Country:US
Practice Address - Phone:972-546-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty