Healthcare Provider Details

I. General information

NPI: 1154780286
Provider Name (Legal Business Name): VAZANA FAMILY DENTAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7807 SW 6TH CT
PLANTATION FL
33324-3203
US

IV. Provider business mailing address

7807 SW 6TH CT
PLANTATION FL
33324-3203
US

V. Phone/Fax

Practice location:
  • Phone: 954-472-8844
  • Fax:
Mailing address:
  • Phone: 954-472-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD ADAM VAZANA
Title or Position: OWNER
Credential: DMD
Phone: 352-219-0765