Provider Demographics
NPI:1487812327
Name:VACAREAN, VIRGIL (DMD)
Entity type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:
Last Name:VACAREAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 LONG PRAIRIE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1755
Mailing Address - Country:US
Mailing Address - Phone:972-355-6042
Mailing Address - Fax:972-355-6083
Practice Address - Street 1:4471 LONG PRAIRIE RD STE 300
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1755
Practice Address - Country:US
Practice Address - Phone:972-355-6042
Practice Address - Fax:972-355-6083
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2434461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3764Medicaid