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General NPI Number Information
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NPI Number | 1174641542
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Entity Type | Individual
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Provider Name | BENNETT J. VACULIK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 903 E LENNON DR STE 108
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City | EMORY
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State | TX
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Zip | 75440-5229
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Country | US
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Telephone | 903-474-6010
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Fax | 903-474-6011
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Provider Business Mailing Address
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Address Line | 903 E LENNON DR STE 108
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City | EMORY
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State | TX
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Zip | 75440-5229
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Country | US
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Telephone | 903-474-6010
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Fax | 903-474-6011
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12250
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License Number State | TX
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