Provider Demographics
NPI:1518410117
Name:JOLDERSMA, DANIEL PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:JOLDERSMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 AUSTON CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1565
Mailing Address - Country:US
Mailing Address - Phone:574-370-2271
Mailing Address - Fax:
Practice Address - Street 1:604 AUSTON CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1565
Practice Address - Country:US
Practice Address - Phone:574-370-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012577A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice