Provider Demographics
NPI:1235261488
Name:VESSEL, ALLEN ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:ANTHONY
Last Name:VESSEL
Suffix:
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 1:2615 STAGSLEAP PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1200
Mailing Address - Country:US
Mailing Address - Phone:719-471-0809
Mailing Address - Fax:
Practice Address - Street 1:685 CITADEL DR E
Practice Address - Street 2:STE. 313
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5314
Practice Address - Country:US
Practice Address - Phone:719-574-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice