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General NPI Number Information
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NPI Number | 1396869020
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Entity Type | Organization
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Legal Business Name | CHRISTIAN VERMEULEN DDS PLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4940 CASCADE RD SE STE 010
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3723
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Country | US
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Telephone | 616-949-3500
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Fax | 616-949-9931
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Provider Business Mailing Address
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Address Line | 4940 CASCADE RD SE STE 010
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3723
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Country | US
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Telephone | 616-949-3500
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Fax | 616-949-9931
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | DR. CHRISTIAN L VERMEULEN
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Credential | DDS
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Telephone | 616-949-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29001018102
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License Number State | MI
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