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NPI Code Detail

MEDICARE: DR. MARC ROBERT VANNESS D.M.D.

MEDICARE:  DR. MARC ROBERT VANNESS  D.M.D.
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
11223G0001XGeneral Practice DentistryHD104909CO

Other Identifiers

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

General Provider Information

NPI Number : 1689765968
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC ROBERT VANNESS D.M.D.
Provider Business Mailing Address
First Line : 155 LAKE AVE STE 201
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-3706
Country : US
Telephone Number : 719-375-5201
Fax Number : 844-656-9696
Provider Business Practice Location Address
First Line : 155 LAKE AVE STE 201
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-3706
Country : US
Telephone Number : 719-375-5201
Fax Number : 844-656-9696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 04/15/2019

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