Provider Demographics
NPI:1093467128
Name:VERTEX DENTAL ONE, PC
Entity Type:Organization
Organization Name:VERTEX DENTAL ONE, PC
Other - Org Name:PARK WEST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-686-4550
Mailing Address - Street 1:13180 WESTPARK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4936
Mailing Address - Country:US
Mailing Address - Phone:281-944-4566
Mailing Address - Fax:281-944-4566
Practice Address - Street 1:13180 WESTPARK DR STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4936
Practice Address - Country:US
Practice Address - Phone:281-944-4566
Practice Address - Fax:281-944-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental