Provider Demographics
NPI:1871827428
Name:VANDERHEIDEN, MEGHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:VANDERHEIDEN
Suffix:
Gender:F
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:PSC 2 BOX 5441
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0055
Mailing Address - Country:US
Mailing Address - Phone:310-309-0575
Mailing Address - Fax:
Practice Address - Street 1:86 TH DENTAL SQUADRON
Practice Address - Street 2:RAMSTEIN AIR BASE, GERMANY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09012-5024
Practice Address - Country:US
Practice Address - Phone:314-479-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588591223X0400X
CAPENDING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics