Provider Demographics
NPI:1265001036
Name:VS-LAPORTE, PLLC
Entity Type:Organization
Organization Name:VS-LAPORTE, PLLC
Other - Org Name:VICTORY SMILES OF PASADENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-460-5657
Mailing Address - Street 1:4002 BURKE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3451
Mailing Address - Country:US
Mailing Address - Phone:832-460-5657
Mailing Address - Fax:346-998-1223
Practice Address - Street 1:4002 BURKE RD STE 400
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3451
Practice Address - Country:US
Practice Address - Phone:832-460-5657
Practice Address - Fax:346-999-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1953960-17Medicaid