Healthcare Provider Details

I. General information

NPI: 1376541185
Provider Name (Legal Business Name): SARANYA VIYAPON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W BERRY ST
FORT WORTH TX
76110-3814
US

IV. Provider business mailing address

1401 W BERRY ST
FORT WORTH TX
76110-3814
US

V. Phone/Fax

Practice location:
  • Phone: 817-921-9616
  • Fax: 817-921-9599
Mailing address:
  • Phone: 817-921-9616
  • Fax: 817-921-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberTX19880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: