Provider Demographics
NPI:1396266730
Name:VISTA DENTAL INC.
Entity type:Organization
Organization Name:VISTA DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BAJJ
Authorized Official - Last Name:VWICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-948-0461
Mailing Address - Street 1:44601 10TH ST. WEST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-948-0461
Mailing Address - Fax:661-723-3684
Practice Address - Street 1:44601 10TH ST. WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-948-0461
Practice Address - Fax:661-723-3684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty