Provider Demographics
NPI:1407561442
Name:VIBRANT SMILES PLLC
Entity Type:Organization
Organization Name:VIBRANT SMILES PLLC
Other - Org Name:VIBRANT FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASODA VARDHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:432-233-1964
Mailing Address - Street 1:1801 E 87TH STREET SUITE 105
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-1826
Mailing Address - Country:US
Mailing Address - Phone:432-233-1964
Mailing Address - Fax:432-558-7299
Practice Address - Street 1:1801 E 87TH STREET
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765
Practice Address - Country:US
Practice Address - Phone:317-292-4054
Practice Address - Fax:432-558-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty