Provider Demographics
NPI:1639394711
Name:VANDERHEIDE, JAMES D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:VANDERHEIDE
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 1:8081 STANTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3237
Mailing Address - Country:US
Mailing Address - Phone:714-521-4131
Mailing Address - Fax:
Practice Address - Street 1:8081 STANTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3237
Practice Address - Country:US
Practice Address - Phone:714-521-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice