Provider Demographics
NPI:1861480568
Name:TAKACS, VINCENT JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOHN
Last Name:TAKACS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 LEIGH LN
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-3377
Mailing Address - Country:US
Mailing Address - Phone:402-884-7394
Mailing Address - Fax:402-294-9250
Practice Address - Street 1:2501 CAPEHART RD
Practice Address - Street 2:STE1I16 OFFUTT AFB
Practice Address - City:OFFUTT A F B
Practice Address - State:NE
Practice Address - Zip Code:68113-1043
Practice Address - Country:US
Practice Address - Phone:402-232-9183
Practice Address - Fax:402-294-9250
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000066351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics