Provider Demographics
NPI:1053532440
Name:VANE, JONATHAN BRUCE (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BRUCE
Last Name:VANE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 STATE ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-3128
Mailing Address - Country:US
Mailing Address - Phone:401-245-6131
Mailing Address - Fax:401-245-5152
Practice Address - Street 1:38 STATE ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-3128
Practice Address - Country:US
Practice Address - Phone:401-245-6131
Practice Address - Fax:401-245-5152
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI83816OtherBLUE CROSS RI
RI610890OtherUNITED CONCORDIA
RI14466-1OtherUHC DENTAL
MARG0041OtherBLUE CROSS MA
RIJB00754Medicaid