Healthcare Provider Details

I. General information

NPI: 1548252059
Provider Name (Legal Business Name): JAMES E. VICK DDS.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 PLUM GLEN CT
HOUSTON TX
77059-3748
US

IV. Provider business mailing address

3703 PLUM GLEN CT
HOUSTON TX
77059-3748
US

V. Phone/Fax

Practice location:
  • Phone: 281-480-8563
  • Fax:
Mailing address:
  • Phone: 281-480-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7363
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: