Provider Demographics
NPI:1780025312
Name:IMPLANTS & GUMCARE PA
Entity Type:Organization
Organization Name:IMPLANTS & GUMCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:T
Authorized Official - Last Name:VADIVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-731-0123
Mailing Address - Street 1:1500 W HEBRON PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6531
Mailing Address - Country:US
Mailing Address - Phone:214-731-0123
Mailing Address - Fax:214-731-1122
Practice Address - Street 1:1500 W HEBRON PKWY STE 108
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6531
Practice Address - Country:US
Practice Address - Phone:214-731-0123
Practice Address - Fax:214-731-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty