Individual
DR. STEPHEN CRAIG VANTASELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
51 W ADAMS AVE, FAIRFIELD, IA 52556-3471
(641) 472-3158
(641) 469-5111
Mailing address
51 W ADAMS AVE, FAIRFIELD, IA 52556-3471
(641) 472-3158
(641) 469-5111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5802
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119917
—
IA
Enumeration date
06/06/2006
Last updated
07/08/2007
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