Provider Demographics
NPI:1710147277
Name:VANDEGRIFT, MARIA ELIZABETH (RDH)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ELIZABETH
Last Name:VANDEGRIFT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ANNAND DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-994-0979
Mailing Address - Fax:
Practice Address - Street 1:2601 ANNAND DR STE 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3719
Practice Address - Country:US
Practice Address - Phone:302-994-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG2-0002053124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist