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General NPI Number Information
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NPI Number | 1053883603
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Entity Type | Organization
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Legal Business Name | VS - LA PORTE, PLLC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 400 W FAIRMONT PKWY
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City | LA PORTE
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State | TX
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Zip | 77571-6308
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Country | US
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Telephone | 832-460-5657
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Fax | 346-998-1223
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Provider Business Mailing Address
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Address Line | 400 W FAIRMONT PKWY
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City | LA PORTE
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State | TX
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Zip | 77571-6308
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Country | US
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Telephone | 832-460-5657
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Fax | 346-998-1223
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JOHN LE
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Credential |
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Telephone | 832-460-5657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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