Provider Demographics
NPI:1336671809
Name:S VAKIL DDS I PA
Entity Type:Organization
Organization Name:S VAKIL DDS I PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-357-2288
Mailing Address - Street 1:4446 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3612
Mailing Address - Country:US
Mailing Address - Phone:919-357-2288
Mailing Address - Fax:
Practice Address - Street 1:4446 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3612
Practice Address - Country:US
Practice Address - Phone:919-357-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty