Healthcare Provider Details

I. General information

NPI: 1962257253
Provider Name (Legal Business Name): VAANI DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 US 181 FRONTAGE SUITE 100
PORTLAND TX
78374
US

IV. Provider business mailing address

10615 YSAMY WAY
SAN ANTONIO TX
78213-1659
US

V. Phone/Fax

Practice location:
  • Phone: 617-834-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KHUSHBU MALHOTRA
Title or Position: DENTIST
Credential: DMD
Phone: 617-834-4646