Provider Demographics
NPI:1932598802
Name:VANDERVELDEN, KAREL (DMD)
Entity Type:Individual
Prefix:
First Name:KAREL
Middle Name:
Last Name:VANDERVELDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 BARRY ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9400
Mailing Address - Country:US
Mailing Address - Phone:616-566-8558
Mailing Address - Fax:
Practice Address - Street 1:200 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408-8478
Practice Address - Country:US
Practice Address - Phone:616-566-8558
Practice Address - Fax:269-561-2997
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist