Healthcare Provider Details

I. General information

NPI: 1932264991
Provider Name (Legal Business Name): DAVID WARREN VAMMEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 EAST SIXTH STREET
TEXARKANA AR
71854-5322
US

IV. Provider business mailing address

505 EAST SIXTH STREET
TEXARKANA AR
71854-5322
US

V. Phone/Fax

Practice location:
  • Phone: 870-774-3723
  • Fax: 870-773-8901
Mailing address:
  • Phone: 870-774-3723
  • Fax: 870-773-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2581
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: