Provider Demographics
NPI:1386052751
Name:VMAX DENTAL
Entity type:Organization
Organization Name:VMAX DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FAGD
Authorized Official - Phone:817-681-4580
Mailing Address - Street 1:110 N PRESTON RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8643
Mailing Address - Country:US
Mailing Address - Phone:972-346-2080
Mailing Address - Fax:972-346-3551
Practice Address - Street 1:110 N PRESTON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8643
Practice Address - Country:US
Practice Address - Phone:972-346-2080
Practice Address - Fax:972-346-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208941223D0004X
TX216561223G0001X
TX212391223P0300X
TX183201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty