Provider Demographics
NPI:1598972416
Name:C V VANNESTE DDS PC
Entity Type:Organization
Organization Name:C V VANNESTE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:VANNESTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-465-4488
Mailing Address - Street 1:37211 HARPER AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3074
Mailing Address - Country:US
Mailing Address - Phone:586-465-4488
Mailing Address - Fax:586-465-7854
Practice Address - Street 1:37211 HARPER AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3074
Practice Address - Country:US
Practice Address - Phone:586-465-4488
Practice Address - Fax:586-465-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4040480Medicaid