Provider Demographics
NPI:1861601015
Name:JON C VAMMEN DDS
Entity type:Organization
Organization Name:JON C VAMMEN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-329-3312
Mailing Address - Street 1:1219 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4101
Mailing Address - Country:US
Mailing Address - Phone:501-329-3312
Mailing Address - Fax:501-329-0576
Practice Address - Street 1:1219 FRONT STREET
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4101
Practice Address - Country:US
Practice Address - Phone:501-329-3312
Practice Address - Fax:501-329-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR24201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty