Provider Demographics
NPI:1649403247
Name:IRVINE, VANESSA DAWN
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:DAWN
Last Name:IRVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PRESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2713
Mailing Address - Country:US
Mailing Address - Phone:770-529-5466
Mailing Address - Fax:
Practice Address - Street 1:4150 MACLAND RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-1202
Practice Address - Country:US
Practice Address - Phone:770-222-1344
Practice Address - Fax:770-222-1345
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant