Provider Demographics
NPI:1730242835
Name:FERNANDO A. VIGNOLO DDS,MS,PA
Entity type:Organization
Organization Name:FERNANDO A. VIGNOLO DDS,MS,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIGNOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PA
Authorized Official - Phone:940-321-3919
Mailing Address - Street 1:3901 FM 2181
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4250
Mailing Address - Country:US
Mailing Address - Phone:940-321-3919
Mailing Address - Fax:940-497-0995
Practice Address - Street 1:3901 FM 2181
Practice Address - Street 2:SUITE 400
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-4250
Practice Address - Country:US
Practice Address - Phone:940-321-3919
Practice Address - Fax:940-497-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty