Provider Demographics
NPI:1346478260
Name:VANNESS, WALTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:VANNESS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 SW 34TH AVE
Mailing Address - Street 2:SUITE 136
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7448
Mailing Address - Country:US
Mailing Address - Phone:352-873-4844
Mailing Address - Fax:352-873-8408
Practice Address - Street 1:3300 SW 34TH AVE
Practice Address - Street 2:SUITE 136
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7448
Practice Address - Country:US
Practice Address - Phone:352-873-4844
Practice Address - Fax:352-873-8408
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist