Provider Demographics
NPI:1932312741
Name:NEIL W. VANIK, DDS, PA
Entity Type:Organization
Organization Name:NEIL W. VANIK, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:VANIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-268-5046
Mailing Address - Street 1:1610 MCGUCKIAN ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4020
Mailing Address - Country:US
Mailing Address - Phone:410-268-5046
Mailing Address - Fax:
Practice Address - Street 1:1610 MCGUCKIAN ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4020
Practice Address - Country:US
Practice Address - Phone:410-268-5046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD084801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty