Provider Demographics
NPI:1285762054
Name:JAMES M. VANES D.D.S. PC
Entity type:Organization
Organization Name:JAMES M. VANES D.D.S. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-362-2529
Mailing Address - Street 1:1025 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-4996
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:46350-4996
Practice Address - Country:US
Practice Address - Phone:219-362-2529
Practice Address - Fax:219-362-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120078191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty