Healthcare Provider Details

I. General information

NPI: 1669750758
Provider Name (Legal Business Name): DANIEL JOSEPH VACENDAK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 PRINCESS ANNE RD SUITE 101
VIRGINIA BEACH VA
23462-7962
US

IV. Provider business mailing address

4540 PRINCESS ANNE RD SUITE 101
VIRGINIA BEACH VA
23462-7962
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-0450
  • Fax: 757-497-6137
Mailing address:
  • Phone: 757-497-0450
  • Fax: 757-497-6137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413228
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: