Provider Demographics
NPI:1427187145
Name:VANDERLINDE, MICHELE ALEXIS (RDH PHD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ALEXIS
Last Name:VANDERLINDE
Suffix:
Gender:F
Credentials:RDH PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 GARIBALDI AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-550-2803
Mailing Address - Fax:
Practice Address - Street 1:717 WALNUT DRIVE
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446
Practice Address - Country:US
Practice Address - Phone:805-238-5334
Practice Address - Fax:805-238-6470
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00001867124Q00000X
CA22352124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist