Provider Demographics
NPI:1285269480
Name:VRANA, MARK ZIGGY
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ZIGGY
Last Name:VRANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 BILL OWENS PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2102
Mailing Address - Country:US
Mailing Address - Phone:903-759-0282
Mailing Address - Fax:
Practice Address - Street 1:2830 BILL OWENS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2102
Practice Address - Country:US
Practice Address - Phone:903-759-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX392771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics