Provider Demographics
NPI:1427499755
Name:SISTA, VINU TANEJA (DDS)
Entity type:Individual
Prefix:DR
First Name:VINU
Middle Name:TANEJA
Last Name:SISTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 GRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3760
Mailing Address - Country:US
Mailing Address - Phone:713-454-5016
Mailing Address - Fax:713-454-5018
Practice Address - Street 1:5230 GRIGGS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-3760
Practice Address - Country:US
Practice Address - Phone:713-454-5016
Practice Address - Fax:713-454-5018
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist