Provider Demographics
NPI:1083962187
Name:DALE L. VANDERSCHELDEN DDS PS
Entity Type:Organization
Organization Name:DALE L. VANDERSCHELDEN DDS PS
Other - Org Name:RAINIER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-826-8800
Mailing Address - Street 1:18209 SR 410 E
Mailing Address - Street 2:STE 300
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-5146
Mailing Address - Country:US
Mailing Address - Phone:253-826-8800
Mailing Address - Fax:
Practice Address - Street 1:18209 SR 410 E
Practice Address - Street 2:STE 300
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-5146
Practice Address - Country:US
Practice Address - Phone:253-826-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty