Provider Demographics
NPI:1750414777
Name:VANNATTER, DORIS A (DDS)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:A
Last Name:VANNATTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N POST RD STE 6
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4225
Mailing Address - Country:US
Mailing Address - Phone:317-897-8970
Mailing Address - Fax:
Practice Address - Street 1:1201 N POST RD STE 6
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4225
Practice Address - Country:US
Practice Address - Phone:317-897-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice