Provider Demographics
NPI:1255411096
Name:VANDERMEULEN, DOUGLAS ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:VANDERMEULEN
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 1:207 WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-8526
Mailing Address - Country:US
Mailing Address - Phone:269-781-6300
Mailing Address - Fax:269-781-8459
Practice Address - Street 1:207 WINSTON DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-8526
Practice Address - Country:US
Practice Address - Phone:269-781-6300
Practice Address - Fax:269-781-8459
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist