MEDICARE: DR. TRENT D VELTKAMP DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE00009699	WA

General Provider Information

NPI Number	:	1265411649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRENT D VELTKAMP DDS

Provider Business Mailing Address
First Line	:	1610 GROVER ST
Second Line	:	STE C1
City	:	LYNDEN
State	:	WA
Zip	:	98264-1539
Country	:	JP
Telephone Number	:	360-354-5691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 GROVER ST
Second Line	:	STE C1
City	:	LYNDEN
State	:	WA
Zip	:	98264-1539
Country	:	JP
Telephone Number	:	360-354-5691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/31/2017

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