Provider Demographics
NPI:1609319169
Name:VAINER, WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VAINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:VAINER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:628 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5425
Mailing Address - Country:US
Mailing Address - Phone:831-295-2002
Mailing Address - Fax:
Practice Address - Street 1:2100 S BASCOM AVE STE 2
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3212
Practice Address - Country:US
Practice Address - Phone:408-377-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist