Provider Demographics
NPI:1215153788
Name:VAMMEN, JON C (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:C
Last Name:VAMMEN
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 1:1219 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4101
Mailing Address - Country:US
Mailing Address - Phone:501-329-3312
Mailing Address - Fax:501-329-0576
Practice Address - Street 1:1219 FRONT STREET
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4101
Practice Address - Country:US
Practice Address - Phone:501-329-3312
Practice Address - Fax:501-329-0576
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR24201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice