Provider Demographics
NPI:1700683471
Name:ESSENTIAL DENTAL MANOR PLLC
Entity type:Organization
Organization Name:ESSENTIAL DENTAL MANOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VU
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-298-6103
Mailing Address - Street 1:16532 SUMMERY ST
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-5455
Mailing Address - Country:US
Mailing Address - Phone:616-990-3555
Mailing Address - Fax:
Practice Address - Street 1:10140 E US 290 HWY
Practice Address - Street 2:UNIT 110
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653
Practice Address - Country:US
Practice Address - Phone:512-298-6103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental