Provider Demographics
NPI:1790721991
Name:JOHN, VANCHIT (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:VANCHIT
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 GUION RD
Mailing Address - Street 2:#280
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-7602
Mailing Address - Country:US
Mailing Address - Phone:317-396-1869
Mailing Address - Fax:317-924-3737
Practice Address - Street 1:3750 GUION RD
Practice Address - Street 2:#280
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-7602
Practice Address - Country:US
Practice Address - Phone:317-396-1869
Practice Address - Fax:317-924-3737
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010162A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics