Provider Demographics
NPI:1558584656
Name:VANDONGEN, CRAIG A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:VANDONGEN
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 1:50 MOOSEHORN RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1112
Mailing Address - Country:US
Mailing Address - Phone:401-886-9955
Mailing Address - Fax:
Practice Address - Street 1:372 IVES ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3929
Practice Address - Country:US
Practice Address - Phone:401-831-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN023341223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics