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General NPI Number Information
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NPI Number | 1083076996
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Entity Type | Organization
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Legal Business Name | D.L. VANDERSCHELDEN, DDS, PC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 18710 MERIDIAN E STE 216
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City | PUYALLUP
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State | WA
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Zip | 98375-2231
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Country | US
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Telephone | 253-846-5588
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Fax | 253-846-5589
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Provider Business Mailing Address
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Address Line | 18710 MERIDIAN E STE 216
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City | PUYALLUP
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State | WA
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Zip | 98375-2231
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Country | US
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Telephone | 253-846-5588
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Fax | 253-846-5589
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALE VANDERSCHELDEN
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Credential | DDS
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Telephone | 253-826-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00005629
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License Number State | WA
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