Provider Demographics
NPI:1912122615
Name:ED VANBELLINGHEN D.D.S. P.C.
Entity Type:Organization
Organization Name:ED VANBELLINGHEN D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANBELLINGHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-556-6401
Mailing Address - Street 1:118 'A' ST W
Mailing Address - Street 2:PO BOX 1089
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-1089
Mailing Address - Country:US
Mailing Address - Phone:503-556-6401
Mailing Address - Fax:503-556-6401
Practice Address - Street 1:118 'A' ST W
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-1089
Practice Address - Country:US
Practice Address - Phone:503-556-6401
Practice Address - Fax:503-556-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR48851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty