Provider Demographics
NPI:1578991071
Name:VITAL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:VITAL FAMILY DENTISTRY
Other - Org Name:VITAL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AHSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-961-4080
Mailing Address - Street 1:5101 MCKINNEY RANCH PKWY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6863
Mailing Address - Country:US
Mailing Address - Phone:972-961-4080
Mailing Address - Fax:
Practice Address - Street 1:5101 MCKINNEY RANCH PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6863
Practice Address - Country:US
Practice Address - Phone:972-961-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty