Provider Demographics
NPI:1427551464
Name:DR MARK A VANZANT PLLC
Entity type:Organization
Organization Name:DR MARK A VANZANT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANZANT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-752-4545
Mailing Address - Street 1:203 BUSINESS CENTER LOOP STE C
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6885
Mailing Address - Country:US
Mailing Address - Phone:406-752-4545
Mailing Address - Fax:406-752-4405
Practice Address - Street 1:203 BUSINESS CENTER LOOP STE C
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6885
Practice Address - Country:US
Practice Address - Phone:406-752-4545
Practice Address - Fax:406-752-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental