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DR. ALEX R VANACKER DDS

>> Dentist >> Dental Providers

Registrant NPI Number: 1083723118

Individual Registrant:
DR. ALEX R VANACKER DDS
Gender: M
Not Sole Proprietor

Location and contact information for practice:
712 BROADWAY ST  PENROSE, CO 81240-9003 US
Tel: 719-372-3041  Fax: 719-372-0163

Contact information for business:
PO BOX 318 712 S BROADWAY PENROSE, CO 81240-0318 US
Tel: 719-372-3041  Fax: 719-372-0163

Registration Information:
NPI: 1083723118
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers
Dentist
COCOLO105937

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
02105930CO05
UNITED CONCORDIA8915201




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