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Organization
FWB DENTAL P.L.L.C.
Active
Organization
FWB DENTAL P.L.L.C.
Active
Other names
Sweetwater Dental Studio
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VLADA MATYTSIN DDS (OWNER/DENTIST)
(832) 939-9999
Entity
Organization
Contact information
Practice address
4840 SWEETWATER BLVD STE A, SUGAR LAND, TX 77479-3403
(832) 939-9999
(832) 939-9997
Mailing address
4840 SWEETWATER BLVD STE A, SUGAR LAND, TX 77479-3403
(832) 939-9999
(832) 939-9997
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30466
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3403552-05
PERFORMING PROVIDER#
TX
05
—
3685794-01
—
TX
Enumeration date
02/24/2017
Last updated
10/24/2018
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