Provider Demographics
NPI:1427223171
Name:VUCHNICH & BLACKER ORTHODONTICS
Entity Type:Organization
Organization Name:VUCHNICH & BLACKER ORTHODONTICS
Other - Org Name:WALTER S. VUCHNICH DDS, MS, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:VUCHNICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PA
Authorized Official - Phone:704-782-5146
Mailing Address - Street 1:1028 LEEANN DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-782-5146
Mailing Address - Fax:704-784-2002
Practice Address - Street 1:1028 LEEANN DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-782-5146
Practice Address - Fax:704-784-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty