Healthcare Provider Details

I. General information

NPI: 1659603264
Provider Name (Legal Business Name): VEST ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 TRINITY DR STE A
LOS ALAMOS NM
87544-2226
US

IV. Provider business mailing address

3250 TRINITY DR STE A
LOS ALAMOS NM
87544-2226
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-4555
  • Fax: 505-662-4373
Mailing address:
  • Phone: 505-662-4555
  • Fax: 505-662-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DEVAN R VEST
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 505-662-4555