Provider Demographics
NPI:1639383722
Name:VANCHERI, MICHAEL ANGELO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:VANCHERI
Suffix:
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 1:312 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1951
Mailing Address - Country:US
Mailing Address - Phone:814-938-7880
Mailing Address - Fax:814-938-6563
Practice Address - Street 1:312 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1951
Practice Address - Country:US
Practice Address - Phone:814-938-7880
Practice Address - Fax:814-938-6563
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025462L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics