Individual
DR. RICHARD JOHN VANEK SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MSCO
Contact information
Practice address
17 OFFICE PARK DR, JACKSONVILLE, NC 28546-3219
(910) 353-5234
(910) 353-1999
Mailing address
17 OFFICE PARK DR, JACKSONVILLE, NC 28546-3219
(910) 330-1235
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3622
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
241156A
MEDICARE PTAN
NC
05
—
6998778
—
NC
01
—
98778
BLUE CROSS BLUE SHIELD NC
NC
Enumeration date
09/11/2006
Last updated
07/28/2015
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