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General NPI Number Information
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NPI Number | 1235425828
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Entity Type | Individual
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Provider Name | CHRISTOPHER VANDERBEEK DDS
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Gender | Male
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 1600 W YOSEMITE AVE STE 3
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City | MANTECA
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State | CA
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Zip | 95337-5188
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Country | US
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Telephone | 209-823-9371
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Fax | 209-823-8374
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Provider Business Mailing Address
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Address Line | 1600 W YOSEMITE AVE STE 3
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City | MANTECA
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State | CA
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Zip | 95337-5188
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Country | US
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Telephone | 209-823-9371
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Fax | 209-823-8374
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 64378
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License Number State | CO
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