Provider Demographics
NPI:1437247608
Name:MAHAN, VANESSA OAKES (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:OAKES
Last Name:MAHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:JO
Other - Last Name:OAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:710 AVERITT RD
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143
Mailing Address - Country:US
Mailing Address - Phone:317-888-4111
Mailing Address - Fax:317-885-2526
Practice Address - Street 1:710 AVERITT RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-888-4111
Practice Address - Fax:317-885-2526
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist