Healthcare Provider Details

I. General information

NPI: 1992821862
Provider Name (Legal Business Name): MICHAEL VANDENBERG, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9226 PFLUMM RD
LENEXA KS
66215-3346
US

IV. Provider business mailing address

9226 PFLUMM RD
LENEXA KS
66215-3346
US

V. Phone/Fax

Practice location:
  • Phone: 913-888-6220
  • Fax: 913-888-8464
Mailing address:
  • Phone: 913-888-6220
  • Fax: 913-888-8464

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: MICHAEL E. VANDENBERG
Title or Position: OWNER
Credential: DDS
Phone: 913-888-6220