Provider Demographics
NPI:1619355435
Name:VGM FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:VGM FAMILY DENTAL PLLC
Other - Org Name:PHANTASTIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:TAMARA
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:713-330-4138
Mailing Address - Street 1:16 UVALDE RD STE F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-1439
Mailing Address - Country:US
Mailing Address - Phone:713-330-4138
Mailing Address - Fax:713-330-4148
Practice Address - Street 1:16 UVALDE RD STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-1439
Practice Address - Country:US
Practice Address - Phone:713-330-4138
Practice Address - Fax:713-330-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty