Provider Demographics
NPI:1164526257
Name:VANEK, RICHARD JOHN SR (DDS MSCO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:VANEK
Suffix:SR
Gender:M
Credentials:DDS MSCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-330-1235
Mailing Address - Fax:
Practice Address - Street 1:17 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-353-5234
Practice Address - Fax:910-353-1999
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6998778Medicaid
NC98778OtherBLUE CROSS BLUE SHIELD NC
NC241156AOtherMEDICARE PTAN
NC98778OtherBLUE CROSS BLUE SHIELD NC