Provider Demographics
NPI:1013361500
Name:ANKIT VASA DDS CORPORATION
Entity Type:Organization
Organization Name:ANKIT VASA DDS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANKIT
Authorized Official - Middle Name:JITEN
Authorized Official - Last Name:VASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-496-9816
Mailing Address - Street 1:7951 LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1627
Mailing Address - Country:US
Mailing Address - Phone:714-496-9816
Mailing Address - Fax:
Practice Address - Street 1:14509 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4875
Practice Address - Country:US
Practice Address - Phone:562-863-5701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60451261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental