Provider Demographics
NPI:1356835946
Name:VANLIERE, ABIGAIL JOY (DDS)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JOY
Last Name:VANLIERE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:JOY
Other - Last Name:NEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2442 COUNTY ROAD H2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4741
Mailing Address - Country:US
Mailing Address - Phone:605-351-8355
Mailing Address - Fax:
Practice Address - Street 1:2110 12TH ST S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-5609
Practice Address - Country:US
Practice Address - Phone:605-692-9463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist