Provider Demographics
NPI:1316065345
Name:VANSOEST, ANTHONY CHARLES (DMD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CHARLES
Last Name:VANSOEST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-1351
Mailing Address - Country:US
Mailing Address - Phone:660-265-4486
Mailing Address - Fax:660-265-4533
Practice Address - Street 1:102 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-1351
Practice Address - Country:US
Practice Address - Phone:660-265-4486
Practice Address - Fax:660-265-4533
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0148351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice