Healthcare Provider Details

I. General information

NPI: 1356072078
Provider Name (Legal Business Name): VANARSDEL FAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 KLONDIKE RD
WEST LAFAYETTE IN
47906-5218
US

IV. Provider business mailing address

490 GAINSBORO DR
WEST LAFAYETTE IN
47906-8888
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-6726
  • Fax:
Mailing address:
  • Phone: 812-345-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SYDNEY MAE VANARSDEL
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 812-345-7612