Healthcare Provider Details

I. General information

NPI: 1871727826
Provider Name (Legal Business Name): BETHANY H VANDEVENDER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BETHANY ORENDORFF

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

IV. Provider business mailing address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-4774
  • Fax:
Mailing address:
  • Phone: 660-826-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2009013243
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPENDING
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: