Provider Demographics
NPI:1629120662
Name:VANSLATE, JON MARC (DDS,FAGD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MARC
Last Name:VANSLATE
Suffix:
Gender:M
Credentials:DDS,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 AUGUSTA DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2062
Mailing Address - Country:US
Mailing Address - Phone:713-783-1993
Mailing Address - Fax:713-266-3670
Practice Address - Street 1:1011 AUGUSTA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2062
Practice Address - Country:US
Practice Address - Phone:713-783-1993
Practice Address - Fax:713-266-3670
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice