MEDICARE: DR. MARC ROBERT VANNESS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	HD104909	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689765968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC ROBERT VANNESS D.M.D.

Provider Business Mailing Address
First Line	:	155 LAKE AVE STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3706
Country	:	US
Telephone Number	:	719-375-5201
Fax Number	:	844-656-9696

Provider Business Practice Location Address
First Line	:	155 LAKE AVE STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3706
Country	:	US
Telephone Number	:	719-375-5201
Fax Number	:	844-656-9696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	04/15/2019

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