Provider Demographics
NPI:1194949149
Name:VANES, JAMES M (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:VANES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-4960
Mailing Address - Country:US
Mailing Address - Phone:219-362-2529
Mailing Address - Fax:219-362-2189
Practice Address - Street 1:1025 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-4960
Practice Address - Country:US
Practice Address - Phone:219-362-2529
Practice Address - Fax:219-362-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1285762054OtherPC NPI #