Provider Demographics
NPI:1770627606
Name:VERTREGT, CARL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:VERTREGT
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 1:12980 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8839
Mailing Address - Country:US
Mailing Address - Phone:616-847-9708
Mailing Address - Fax:
Practice Address - Street 1:1848 E SHERMAN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1963
Practice Address - Country:US
Practice Address - Phone:231-737-7745
Practice Address - Fax:231-737-3296
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010099651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice