Provider Demographics
NPI:1699380584
Name:VANDER LINDE FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:VANDER LINDE FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-245-3205
Mailing Address - Street 1:2609 BRETON RD. SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-245-3205
Mailing Address - Fax:
Practice Address - Street 1:2609 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5631
Practice Address - Country:US
Practice Address - Phone:616-245-3205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental