Provider Demographics
NPI:1558641720
Name:VASA, ANKIT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANKIT
Middle Name:J
Last Name:VASA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11455 CARSON ST STE E
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2581
Mailing Address - Country:US
Mailing Address - Phone:714-496-9816
Mailing Address - Fax:
Practice Address - Street 1:11455 CARSON ST STE E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-2581
Practice Address - Country:US
Practice Address - Phone:714-496-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist