| Fwb Dental P.l.l.c. | |
|
4840 Sweetwater Blvd Ste A Sugar Land TX 77479-3403 | |
| (832) 939-9999 | |
| (832) 939-9997 |
| Full Name | Fwb Dental P.l.l.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4840 Sweetwater Blvd Ste A, Sugar Land, Texas |
| Authorized Official Name and Position | Vlada Matytsin (OWNER/DENTIST) |
| Authorized Official Contact | 8329399999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fwb Dental P.l.l.c. 4840 Sweetwater Blvd Ste A Sugar Land TX 77479-3403 Ph: (832) 939-9999 | Fwb Dental P.l.l.c. 4840 Sweetwater Blvd Ste A Sugar Land TX 77479-3403 Ph: (832) 939-9999 |
| NPI Number | 1366982324 |
|---|---|
| Provider Enumeration Date | 02/24/2017 |
| Last Update Date | 10/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366982324 | NPI | - | NPPES |
| 3685794-01 | Medicaid | TX | |
| 3403552-05 | Other | TX | PERFORMING PROVIDER# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30466 (Texas) | Primary |
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