Provider Demographics
NPI:1912574161
Name:VANARSDEL, SYDNEY MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:MAE
Last Name:VANARSDEL
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 1:3725 ROME DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4490
Mailing Address - Country:US
Mailing Address - Phone:765-447-2725
Mailing Address - Fax:765-449-2373
Practice Address - Street 1:3725 ROME DR STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4490
Practice Address - Country:US
Practice Address - Phone:765-447-2725
Practice Address - Fax:765-449-2373
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013638A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice