Healthcare Provider Details

I. General information

NPI: 1790721991
Provider Name (Legal Business Name): VANCHIT JOHN D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 GUION RD #280
INDIANAPOLIS IN
46222-7602
US

IV. Provider business mailing address

3750 GUION RD #280
INDIANAPOLIS IN
46222-7602
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1869
  • Fax: 317-924-3737
Mailing address:
  • Phone: 317-396-1869
  • Fax: 317-924-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12010162A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: