Provider Demographics
NPI:1649554072
Name:VESTA DENTAL SUPPLIES AND SERVICES
Entity type:Organization
Organization Name:VESTA DENTAL SUPPLIES AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEMASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1888-819-7919
Mailing Address - Street 1:3110 WILLETT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3042
Mailing Address - Country:US
Mailing Address - Phone:412-307-5477
Mailing Address - Fax:188-881-9791
Practice Address - Street 1:3110 WILLETT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3042
Practice Address - Country:US
Practice Address - Phone:412-307-5477
Practice Address - Fax:188-881-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies