Provider Demographics
NPI:1336325844
Name:STEPHEN C. VANTASELL, D.D.S.,P.C.
Entity Type:Organization
Organization Name:STEPHEN C. VANTASELL, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANTASELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-472-3158
Mailing Address - Street 1:51 W ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3471
Mailing Address - Country:US
Mailing Address - Phone:641-472-3158
Mailing Address - Fax:641-469-5111
Practice Address - Street 1:51 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3471
Practice Address - Country:US
Practice Address - Phone:641-472-3158
Practice Address - Fax:641-469-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5802122300000X
IA6820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty