Provider Demographics
NPI:1609254069
Name:RADEMACHER, ANTHONY CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:RADEMACHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 POST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2543
Mailing Address - Country:US
Mailing Address - Phone:616-403-8296
Mailing Address - Fax:
Practice Address - Street 1:1459 POST AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2543
Practice Address - Country:US
Practice Address - Phone:616-403-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY96311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program