Provider Demographics
NPI:1366582132
Name:NANTZ, VANNAH ELLEN (DDS)
Entity type:Individual
Prefix:MRS
First Name:VANNAH
Middle Name:ELLEN
Last Name:NANTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:VANNAH
Other - Middle Name:ELLEN
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:79 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4735
Mailing Address - Country:US
Mailing Address - Phone:937-433-0110
Mailing Address - Fax:937-433-1407
Practice Address - Street 1:79 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-4735
Practice Address - Country:US
Practice Address - Phone:937-433-0110
Practice Address - Fax:937-433-1407
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH179141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice