Provider Demographics
NPI:1689238289
Name:VICKERS FAMILY DENTAL
Entity Type:Organization
Organization Name:VICKERS FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:281-440-1200
Mailing Address - Street 1:PO BOX 11470
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1470
Mailing Address - Country:US
Mailing Address - Phone:281-440-1200
Mailing Address - Fax:281-440-3578
Practice Address - Street 1:13810 CHAMPION FOREST DR STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1868
Practice Address - Country:US
Practice Address - Phone:281-440-1200
Practice Address - Fax:281-440-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental