Provider Demographics
NPI:1184832826
Name:LIONEL R. VACHON D.D.S. P.A.
Entity Type:Organization
Organization Name:LIONEL R. VACHON D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:VACHON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:207-324-4003
Mailing Address - Street 1:844 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3524
Mailing Address - Country:US
Mailing Address - Phone:207-324-4003
Mailing Address - Fax:207-324-6734
Practice Address - Street 1:844 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3524
Practice Address - Country:US
Practice Address - Phone:207-324-4003
Practice Address - Fax:207-324-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty