1083618664 NPI number — IVI Z SANGUINETTI DDS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083618664 NPI number — IVI Z SANGUINETTI DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IVI Z SANGUINETTI DDS PA
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:
Provider Other Organization Name Type Code:
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:
1083618664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6920 GARTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77521-9646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-421-5950
Provider Business Mailing Address Fax Number:
281-421-7828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6920 GARTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-9646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-421-5950
Provider Business Practice Location Address Fax Number:
281-421-7828
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SANGUINETTI
Authorized Official First Name:
IVI
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
DENTIST / OWNER / PRESIDENT
Authorized Official Telephone Number:
281-421-5950

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  17943 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111401501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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