1336869130 NPI number — VIBE DENTISTRY PLLC

Table of content: (NPI 1336869130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336869130 NPI number — VIBE DENTISTRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIBE DENTISTRY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIBE DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336869130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 734753
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-4753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-557-3474
Provider Business Mailing Address Fax Number:
832-442-9796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3784 RAYFORD RD # 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-557-3474
Provider Business Practice Location Address Fax Number:
832-442-9796
Provider Enumeration Date:
08/31/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD OF CREDENTIALING
Authorized Official Telephone Number:
972-869-3789

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)