Provider Demographics
NPI:1992832059
Name:STRENTA, VANNI RUSS (DMD)
Entity type:Individual
Prefix:
First Name:VANNI
Middle Name:RUSS
Last Name:STRENTA
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 1:3914 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5413
Mailing Address - Country:US
Mailing Address - Phone:904-573-9560
Mailing Address - Fax:904-573-9562
Practice Address - Street 1:3914 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-5413
Practice Address - Country:US
Practice Address - Phone:904-573-9560
Practice Address - Fax:904-573-9562
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN135481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery