Provider Demographics
NPI:1063510121
Name:VESS, FREMONT ARCHIBALD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREMONT
Middle Name:ARCHIBALD
Last Name:VESS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-0204
Mailing Address - Country:US
Mailing Address - Phone:540-992-1020
Mailing Address - Fax:540-992-1024
Practice Address - Street 1:24 TINKERMILL ROAD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083
Practice Address - Country:US
Practice Address - Phone:540-922-1020
Practice Address - Fax:540-992-1024
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist