MEDICARE: VIJITHA VASANTHA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D009137	AZ
2	122300000X	Dentist	31644	TX

General Provider Information

NPI Number	:	1659763811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJITHA VASANTHA DDS

Provider Business Mailing Address
First Line	:	2537 GOSLING DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-0014
Country	:	US
Telephone Number	:	817-281-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5206 RUFE SNOW DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6689
Country	:	US
Telephone Number	:	817-281-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	11/17/2025

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