Provider Demographics
NPI:1073077970
Name:VASA DENTAL GROUP INC
Entity Type:Organization
Organization Name:VASA DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANKIT
Authorized Official - Middle Name:
Authorized Official - Last Name:VASA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-994-4334
Mailing Address - Street 1:7851 WALKER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1746
Mailing Address - Country:US
Mailing Address - Phone:714-994-4334
Mailing Address - Fax:714-312-3563
Practice Address - Street 1:7851 WALKER ST STE 201
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1746
Practice Address - Country:US
Practice Address - Phone:714-994-4334
Practice Address - Fax:714-312-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental