Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS037719 | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS037719 | PA |
NPI | 1083871347 |
---|---|
Provider Name | John Vakkas |
First Address | Lititz, PA 17543-7507 |
Second Address | Lititz, PA 17543-7507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 27/01/2017 |