Provider Demographics
NPI:1689960809
Name:DOUGLAS W. VIERRA, D.D.S., INC.
Entity Type:Organization
Organization Name:DOUGLAS W. VIERRA, D.D.S., INC.
Other - Org Name:PLAZA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:VIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-270-4333
Mailing Address - Street 1:4205 SAN FELIPE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1505
Mailing Address - Country:US
Mailing Address - Phone:408-270-4333
Mailing Address - Fax:408-270-3373
Practice Address - Street 1:4205 SAN FELIPE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1505
Practice Address - Country:US
Practice Address - Phone:408-270-4333
Practice Address - Fax:408-270-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326261223G0001X
CA401481223G0001X
CA553641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty