=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295871408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OTTO JOHN VNEK, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 BARIBEAU DR
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04011-3241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-725-4311
-----------------------------------------------------
Fax | 207-725-9849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82 BARIBEAU DR
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04011-3241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-725-4311
-----------------------------------------------------
Fax | 207-725-9849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. OTTO JOHN VNEK
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 207-725-4311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------