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General NPI Number Information
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NPI Number | 1538209846
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Entity Type | Individual
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Provider Name | CAMILLE MARIE VANDEVANTER DDS, MSD
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 33507 - 9TH AVE. S. BUILDING G
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City | FEDERAL WAY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 253-661-7228
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Fax | 253-661-9508
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Provider Business Mailing Address
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Address Line | 33507 - 9TH AVE. S. BUILDING G
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City | FEDERAL WAY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 253-661-7228
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Fax | 253-661-9508
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6444
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License Number State | WA
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