Provider Demographics
NPI:1922126515
Name:VANBELLINGHEN, EDMOND ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:ARTHUR
Last Name:VANBELLINGHEN
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 1:118 A ST WEST
Mailing Address - Street 2:PO BOX 1089
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-1089
Mailing Address - Country:US
Mailing Address - Phone:503-556-6401
Mailing Address - Fax:503-556-6401
Practice Address - Street 1:118 A ST W
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-1089
Practice Address - Country:US
Practice Address - Phone:503-556-6401
Practice Address - Fax:503-556-6401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR48851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice