Provider Demographics
NPI:1083076996
Name:D.L. VANDERSCHELDEN, DDS, PC
Entity Type:Organization
Organization Name:D.L. VANDERSCHELDEN, DDS, PC
Other - Org Name:RAINIER DENTAL PUYALLUP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERSCHELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-826-8800
Mailing Address - Street 1:18710 MERIDIAN E STE 216
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2231
Mailing Address - Country:US
Mailing Address - Phone:253-846-5588
Mailing Address - Fax:253-846-5589
Practice Address - Street 1:18710 MERIDIAN E STE 216
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2231
Practice Address - Country:US
Practice Address - Phone:253-846-5588
Practice Address - Fax:253-846-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty