Provider Demographics
NPI:1821251224
Name:VANDEVELDE AND MATHESON, D.D.S.,P.C.
Entity Type:Organization
Organization Name:VANDEVELDE AND MATHESON, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:VANDEVELDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-835-4226
Mailing Address - Street 1:124 N HANSELMAN ST
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1201
Mailing Address - Country:US
Mailing Address - Phone:989-269-8401
Mailing Address - Fax:989-269-2031
Practice Address - Street 1:124 N HANSELMAN ST
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1201
Practice Address - Country:US
Practice Address - Phone:989-269-8401
Practice Address - Fax:989-269-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty