=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982736864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEBRON ORTHODONTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 W HEBRON PKWY SUITE #122
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-492-3900
-----------------------------------------------------
Fax | 972-492-3922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 PRESTONWOOD DR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-8852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-306-2721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. VINCENT VIET TO
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 972-306-2721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 21697
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------