Provider Demographics
NPI:1982914958
Name:F & B SURGICAL AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:F & B SURGICAL AND COSMETIC DENTISTRY
Other - Org Name:DR. VIDAL & ASSOCIATES DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:X
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-767-1037
Mailing Address - Street 1:3100 BROADWAY ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-2338
Mailing Address - Country:US
Mailing Address - Phone:832-767-1037
Mailing Address - Fax:
Practice Address - Street 1:3100 BROADWAY ST STE 101B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-2338
Practice Address - Country:US
Practice Address - Phone:832-767-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216403001Medicaid