Healthcare Provider Details

I. General information

NPI: 1487812327
Provider Name (Legal Business Name): VIRGIL VACAREAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4471 LONG PRAIRIE RD STE 300
FLOWER MOUND TX
75028-1755
US

IV. Provider business mailing address

4471 LONG PRAIRIE RD STE 300
FLOWER MOUND TX
75028-1755
US

V. Phone/Fax

Practice location:
  • Phone: 972-355-6042
  • Fax: 972-355-6083
Mailing address:
  • Phone: 972-355-6042
  • Fax: 972-355-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number243446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: