Provider Demographics
NPI:1154780286
Name:VAZANA FAMILY DENTAL, PA
Entity type:Organization
Organization Name:VAZANA FAMILY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:VAZANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-219-0765
Mailing Address - Street 1:7807 SW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3203
Mailing Address - Country:US
Mailing Address - Phone:954-472-8844
Mailing Address - Fax:
Practice Address - Street 1:7807 SW 6TH CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3203
Practice Address - Country:US
Practice Address - Phone:954-472-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty