Provider Demographics
NPI:1295397875
Name:WADDEN, VANESSA GENERAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:GENERAL
Last Name:WADDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:ACOMPANADO
Other - Last Name:GENERAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1616 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3435
Mailing Address - Country:US
Mailing Address - Phone:563-263-0017
Mailing Address - Fax:
Practice Address - Street 1:1616 YOUNG AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3435
Practice Address - Country:US
Practice Address - Phone:563-263-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS096731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice