Provider Demographics
NPI:1528276243
Name:VACHON, LIONEL ROSS (DDS)
Entity type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:ROSS
Last Name:VACHON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3524
Mailing Address - Country:US
Mailing Address - Phone:207-324-4003
Mailing Address - Fax:207-324-6734
Practice Address - Street 1:844 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3524
Practice Address - Country:US
Practice Address - Phone:207-324-4003
Practice Address - Fax:207-324-6734
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME29351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice