Provider Demographics
NPI:1891923801
Name:VERMEER, MICAH JESS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:JESS
Last Name:VERMEER
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 1:2300 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7575
Mailing Address - Country:US
Mailing Address - Phone:641-628-2671
Mailing Address - Fax:641-628-8914
Practice Address - Street 1:2300 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7575
Practice Address - Country:US
Practice Address - Phone:641-628-2671
Practice Address - Fax:641-628-8914
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08649122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist