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General NPI Number Information
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NPI Number | 1598047748
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Entity Type | Organization
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Legal Business Name | WALTER C. VAIL, D.D.S
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 5925 FOREST LN SUITE 420
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City | DALLAS
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State | TX
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Zip | 75230-2712
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Country | US
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Telephone | 214-691-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 FOREST LN SUITE 420
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City | DALLAS
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State | TX
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Zip | 75230-2712
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Country | US
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Telephone | 214-691-8200
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | WALTER JAYSON VAIL
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Credential |
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Telephone | 214-691-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9264
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License Number State | TX
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