Provider Demographics
NPI:1710774575
Name:DAVID VACA JR DDS PA
Entity type:Organization
Organization Name:DAVID VACA JR DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VACA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-663-5895
Mailing Address - Street 1:3121 H G MOSLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2942
Mailing Address - Country:US
Mailing Address - Phone:903-663-5895
Mailing Address - Fax:
Practice Address - Street 1:3121 H G MOSLEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2942
Practice Address - Country:US
Practice Address - Phone:903-663-5895
Practice Address - Fax:903-663-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies