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General NPI Number Information
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NPI Number | 1558584656
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Entity Type | Individual
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Provider Name | CRAIG A VANDONGEN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 372 IVES ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-3929
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Country | US
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Telephone | 401-831-3777
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MOOSEHORN RD
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1112
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Country | US
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Telephone | 401-886-9955
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DEN02334
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License Number State | RI
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