Provider Demographics
NPI: | 1821438144 |
---|---|
Name: | VAS DENTAL LLC |
Entity Type: | Organization |
Organization Name: | VAS DENTAL LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGING MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VANDANA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SONI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 617-501-7773 |
Mailing Address - Street 1: | 534 COMMONWEALTH AVE |
Mailing Address - Street 2: | UNIT 4A |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02215-2611 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-501-7773 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 950 BROADWAY |
Practice Address - Street 2: | COMM UNIT 1 |
Practice Address - City: | CHELSEA |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02150-2282 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-889-5437 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | VAS DENTAL LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2013-07-01 |
Last Update Date: | 2015-01-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | DN20698 | 1223P0221X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Single Specialty |