Provider Demographics
NPI:1861546269
Name:VETTER, LONNIE RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:RAY
Last Name:VETTER
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 1:820 N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2023
Mailing Address - Country:US
Mailing Address - Phone:417-256-5223
Mailing Address - Fax:417-256-8717
Practice Address - Street 1:820 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2023
Practice Address - Country:US
Practice Address - Phone:417-256-5223
Practice Address - Fax:417-256-8717
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1275301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice