Provider Demographics
NPI:1356554166
Name:VANVLIET, MARTIN F (DMD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:F
Last Name:VANVLIET
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 WOODSIDE PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1413
Mailing Address - Country:US
Mailing Address - Phone:845-691-8330
Mailing Address - Fax:845-691-7019
Practice Address - Street 1:19 WOODSIDE PL
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1413
Practice Address - Country:US
Practice Address - Phone:845-691-8330
Practice Address - Fax:845-691-7019
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316211223X0400X
NJ118431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics