Provider Demographics
NPI:1437271061
Name:VANEMMERIK, BRIAN P (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:VANEMMERIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 REACH RD
Mailing Address - Street 2:
Mailing Address - City:SEDGWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04676-3006
Mailing Address - Country:US
Mailing Address - Phone:207-367-2631
Mailing Address - Fax:
Practice Address - Street 1:356 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:ME
Practice Address - Zip Code:04681-3217
Practice Address - Country:US
Practice Address - Phone:207-367-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME33711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice