Provider Demographics
NPI:1225656945
Name:VANLUE ORTHODONTICS, PC
Entity Type:Organization
Organization Name:VANLUE ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:VANLUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-985-8040
Mailing Address - Street 1:5821 CORTE DE CASA CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1267
Mailing Address - Country:US
Mailing Address - Phone:317-985-8040
Mailing Address - Fax:
Practice Address - Street 1:9855 W. DEER SPRINGS WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NE
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:317-985-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental