Provider Demographics
NPI:1447469036
Name:VANNI, JOHN R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:VANNI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5187 MAYFIELD RD
Mailing Address - Street 2:STE 40
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2466
Mailing Address - Country:US
Mailing Address - Phone:440-446-0110
Mailing Address - Fax:
Practice Address - Street 1:5187 MAYFIELD RD
Practice Address - Street 2:SUITE 40
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2468
Practice Address - Country:US
Practice Address - Phone:440-446-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-174341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice