Provider Demographics
NPI:1811429152
Name:GARY VANDER VLIET DMD
Entity type:Organization
Organization Name:GARY VANDER VLIET DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER VLIET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MAGD
Authorized Official - Phone:908-852-8858
Mailing Address - Street 1:486 SCHOOLEYS MOUNTAIN RD STE 10
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4000
Mailing Address - Country:US
Mailing Address - Phone:908-852-8858
Mailing Address - Fax:908-852-2249
Practice Address - Street 1:486 SCHOOLEYS MOUNTAIN RD STE 10
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4000
Practice Address - Country:US
Practice Address - Phone:908-852-8858
Practice Address - Fax:908-852-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies