Provider Demographics
NPI:1528365848
Name:DR. MICHAEL VANN & ASSOCIATES, INC
Entity Type:Organization
Organization Name:DR. MICHAEL VANN & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:205-508-3399
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-0582
Mailing Address - Country:US
Mailing Address - Phone:205-508-3399
Mailing Address - Fax:
Practice Address - Street 1:1808 GADSDEN HWY
Practice Address - Street 2:SUITE 134
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3139
Practice Address - Country:US
Practice Address - Phone:205-508-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. MICHAEL VANN & ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA152931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty