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Organization
VIVEDE INC
Active
Organization
VIVEDE INC
Active
Other names
Keller Parkway Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEEPA VENUGOPAL DDS (CEO)
(313) 549-1401
Entity
Organization
Contact information
Practice address
359 KELLER PKWY, KELLER, TX 76248-2206
(817) 431-6995
Mailing address
1508 CHERRY GLOW CT, KELLER, TX 76248-2034
(313) 549-1401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30974
TEXAS DENTAL LICENSE
TX
Enumeration date
10/02/2018
Last updated
10/02/2018
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