Provider Demographics
NPI:1760421952
Name:VANDERLUGT, DAVID F (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:VANDERLUGT
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 1:2008 EASTCASTLE DR SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8874
Mailing Address - Country:US
Mailing Address - Phone:616-455-8400
Mailing Address - Fax:
Practice Address - Street 1:2008 EASTCASTLE DR SE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-8874
Practice Address - Country:US
Practice Address - Phone:616-455-8400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist