Provider Demographics
NPI:1033801469
Name:VDP ROCHESTER LLC
Entity Type:Organization
Organization Name:VDP ROCHESTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-223-3121
Mailing Address - Street 1:1329 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-2107
Mailing Address - Country:US
Mailing Address - Phone:574-223-3121
Mailing Address - Fax:574-406-8136
Practice Address - Street 1:1329 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-2107
Practice Address - Country:US
Practice Address - Phone:574-223-3121
Practice Address - Fax:574-406-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922016260OtherDENTIST
1154715324OtherDENTIST