Provider Demographics
NPI:1750695268
Name:VANTA, DIANA M (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:VANTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W I-30 FRONTAGE RD
Mailing Address - Street 2:STE H
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-7513
Mailing Address - Country:US
Mailing Address - Phone:469-723-4000
Mailing Address - Fax:
Practice Address - Street 1:3250 W PLEASANT RUN RD
Practice Address - Street 2:#190
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1050
Practice Address - Country:US
Practice Address - Phone:469-765-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist