Provider Demographics
NPI:1912092701
Name:VIGNOLO, FERNANDO A (DDS, MS)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:A
Last Name:VIGNOLO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 FM 2181
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4250
Mailing Address - Country:US
Mailing Address - Phone:940-321-3919
Mailing Address - Fax:940-497-0995
Practice Address - Street 1:3901 FM 2181
Practice Address - Street 2:SUITE 400
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-4250
Practice Address - Country:US
Practice Address - Phone:940-321-3919
Practice Address - Fax:940-497-0995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics