MEDICARE: VEST ORTHODONTICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659603264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEST ORTHODONTICS PC

Provider Business Mailing Address
First Line	:	3250 TRINITY DR STE A
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2226
Country	:	US
Telephone Number	:	505-662-4555
Fax Number	:	505-662-4373

Provider Business Practice Location Address
First Line	:	3250 TRINITY DR STE A
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2226
Country	:	US
Telephone Number	:	505-662-4555
Fax Number	:	505-662-4373

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEVAN R VEST
Credential	:	DDS, MS
Telephone Number	:	505-662-4555

Provider Enumeration Date	:	02/06/2010
Last Update Date	:	07/13/2010

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Directions to “VEST ORTHODONTICS PC ” Practice Location

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