Provider Demographics
NPI:1639251713
Name:VANN, MICHAEL KING II (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KING
Last Name:VANN
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 GADSDEN HWY STE 134
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3140
Mailing Address - Country:US
Mailing Address - Phone:205-508-3399
Mailing Address - Fax:
Practice Address - Street 1:1808 GADSDEN HWY STE 134
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3140
Practice Address - Country:US
Practice Address - Phone:205-508-3399
Practice Address - Fax:205-623-0834
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL126434Medicaid