Provider Demographics
NPI:1679714638
Name:VERMEULEN, CHRISTIAN L (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:L
Last Name:VERMEULEN
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 1:4940 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3708
Mailing Address - Country:US
Mailing Address - Phone:616-949-3500
Mailing Address - Fax:616-949-9931
Practice Address - Street 1:4940 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3708
Practice Address - Country:US
Practice Address - Phone:616-949-3500
Practice Address - Fax:616-949-9931
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice