Provider Demographics
NPI:1396869020
Name:CHRISTIAN VERMEULEN DDS PLC
Entity type:Organization
Organization Name:CHRISTIAN VERMEULEN DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERMEULEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-949-3500
Mailing Address - Street 1:4940 CASCADE RD SE STE 010
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3723
Mailing Address - Country:US
Mailing Address - Phone:616-949-3500
Mailing Address - Fax:616-949-9931
Practice Address - Street 1:4940 CASCADE RD SE STE 010
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3723
Practice Address - Country:US
Practice Address - Phone:616-949-3500
Practice Address - Fax:616-949-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29001018102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty