Provider Demographics
NPI:1972721488
Name:VANDERZEE, JOHN CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:VANDERZEE
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 1:212 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-1504
Mailing Address - Country:US
Mailing Address - Phone:712-472-3771
Mailing Address - Fax:712-472-3772
Practice Address - Street 1:212 1ST AVE
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1504
Practice Address - Country:US
Practice Address - Phone:712-472-3771
Practice Address - Fax:712-472-3772
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist