Provider Demographics
NPI:1982959755
Name:VANDERWAAL, ARTHUR SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:SCOTT
Last Name:VANDERWAAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14614 FM 529 RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3510
Mailing Address - Country:US
Mailing Address - Phone:281-429-8558
Mailing Address - Fax:
Practice Address - Street 1:14614 FM 529 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3510
Practice Address - Country:US
Practice Address - Phone:281-429-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029050122300000X
TX34966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist