Provider Demographics
NPI:1932335106
Name:VEACH, WILBUR ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILBUR
Middle Name:ALEXANDER
Last Name:VEACH
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 1:5261 WILMINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-0639
Mailing Address - Country:US
Mailing Address - Phone:765-414-0079
Mailing Address - Fax:
Practice Address - Street 1:1 N OHIO ST
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47977-8877
Practice Address - Country:US
Practice Address - Phone:219-261-2217
Practice Address - Fax:219-261-2722
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011311A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice