Kenneth Wayne Vansickle JR. D.M.D

NPI 1033196118 - Dentist - 1223G0001X

NPI Details
NPI 1033196118
Gender Male
Enumeration Date 12/29/2005
Last Updated 04/23/2013
Entity Type Individual
Active Over 10 years ago
Practice Location
2008 SAINT MICHAELS DR
SUITE B
SANTA FE NM, 87505-7682, US
Phone (505) 474-4993
Fax (505) 474-4973
Business Location
16 ARCADE UNIT 198747
NASHVILLE TN, 37219-1994, US
Phone (615) 750-0343
Fax (615) 986-1705
Toxanomy
Taxonomy Code 1223G0001X
License State New Mexico
License Number DD2304
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According to our database, Dr. Kenneth Wayne Vansickle JR. D.M.D NPI is 1033196118, taxonomy code is 1223G0001X and license number is DD2304, license state is located at New Mexico. Kenneth Wayne Vansickle JR. D.M.D physically located at 2008 Saint Michaels Dr, Santa Fe NM, 87505-7682. NPI Number Kenneth Wayne Vansickle JR. D.M.D has the Individual type.

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1033196118 NPI number is provided on an as is basis without warranty of any kind. 1033196118 is maintained by the National Plan & Provider Enumeration System. The contents of Kenneth Wayne Vansickle JR. D.M.D are for informational purposes only.