Provider Demographics
NPI:1275771388
Name:VEGA DENTAL LLC
Entity Type:Organization
Organization Name:VEGA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-639-1400
Mailing Address - Street 1:164 SCOTT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7281
Mailing Address - Country:US
Mailing Address - Phone:203-639-1400
Mailing Address - Fax:203-639-1999
Practice Address - Street 1:164 SCOTT ST STE 5
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7281
Practice Address - Country:US
Practice Address - Phone:203-639-1400
Practice Address - Fax:203-639-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty