MEDICARE: VITA DENTAL GOSLING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	26066	TX

General Provider Information

NPI Number	:	1912418732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITA DENTAL GOSLING PLLC

Provider Business Mailing Address
First Line	:	5250 FM 2920 RD
Second Line	:	STE D
City	:	SPRING
State	:	TX
Zip	:	77388-3003
Country	:	US
Telephone Number	:	609-271-0278
Fax Number	:

Provider Business Practice Location Address
First Line	:	5250 FM 2920 RD
Second Line	:	STE D
City	:	SPRING
State	:	TX
Zip	:	77388-3003
Country	:	US
Telephone Number	:	609-271-0278
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SANG PIL YU
Credential	:	DDS
Telephone Number	:	609-271-0278

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	10/19/2017

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