Provider Demographics
NPI:1053496232
Name:POOSKOOR, VINEETA (DDS)
Entity Type:Individual
Prefix:
First Name:VINEETA
Middle Name:
Last Name:POOSKOOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 LIBERTY GROVE RD STE 50
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089
Mailing Address - Country:US
Mailing Address - Phone:972-401-6900
Mailing Address - Fax:972-914-5430
Practice Address - Street 1:8701 LIBERTY GROVE RD STE 50
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089
Practice Address - Country:US
Practice Address - Phone:972-401-6900
Practice Address - Fax:972-914-5430
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1968703Medicaid