Provider Demographics
NPI:1043958952
Name:NICHOLAS J VANDEMOORTEL, DDS, PC
Entity Type:Organization
Organization Name:NICHOLAS J VANDEMOORTEL, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VANDEMOORTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-964-0357
Mailing Address - Street 1:572 MILITARY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7599
Mailing Address - Country:US
Mailing Address - Phone:269-964-0357
Mailing Address - Fax:269-964-0929
Practice Address - Street 1:572 MILITARY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7599
Practice Address - Country:US
Practice Address - Phone:269-964-0357
Practice Address - Fax:269-964-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental