Provider Demographics
NPI:1972973808
Name:VIP DENTAL CENTER INC.
Entity type:Organization
Organization Name:VIP DENTAL CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ENDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-202-1053
Mailing Address - Street 1:32919 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3121
Mailing Address - Country:US
Mailing Address - Phone:727-202-1054
Mailing Address - Fax:844-727-9580
Practice Address - Street 1:32919 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3121
Practice Address - Country:US
Practice Address - Phone:727-202-1054
Practice Address - Fax:844-727-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL132921223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty