Provider Demographics
NPI:1386714061
Name:NASVESCHUK, BLANE JON (DMD)
Entity type:Individual
Prefix:DR
First Name:BLANE
Middle Name:JON
Last Name:NASVESCHUK
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 1:65 N MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-747-4544
Mailing Address - Fax:802-747-4921
Practice Address - Street 1:65 N MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-747-4544
Practice Address - Fax:802-747-4921
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist