Provider Demographics
NPI:1588089650
Name:CHAD J VANOURNY DDS, PLLC
Entity type:Organization
Organization Name:CHAD J VANOURNY DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VANOURNY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-331-6088
Mailing Address - Street 1:13557 STEELECROFT PKWY
Mailing Address - Street 2:STE. 2400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7550
Mailing Address - Country:US
Mailing Address - Phone:704-594-8496
Mailing Address - Fax:
Practice Address - Street 1:13557 STEELECROFT PKWY
Practice Address - Street 2:STE. 2400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7550
Practice Address - Country:US
Practice Address - Phone:704-594-8496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty