Provider Demographics
NPI:1568114528
Name:VAC ORTHODONTICS
Entity Type:Organization
Organization Name:VAC ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:HANSON
Authorized Official - Last Name:VACCARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-548-4255
Mailing Address - Street 1:482 MERCANTILE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-2102
Mailing Address - Country:US
Mailing Address - Phone:803-548-4255
Mailing Address - Fax:
Practice Address - Street 1:482 MERCANTILE PL STE 104
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-2102
Practice Address - Country:US
Practice Address - Phone:803-548-4255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty