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General NPI Number Information
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NPI Number | 1730075854
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Entity Type | Organization
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Legal Business Name | VANDERPOOL FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 10911 N JACOB SMART BLVD STE C
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City | RIDGELAND
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State | SC
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Zip | 29936-2728
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Country | US
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Telephone | 843-898-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SKIPPERLING LN
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City | BLUFFTON
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State | SC
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Zip | 29909-7060
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Country | US
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Telephone | 937-903-1850
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | JUSTIN SCOTT VANDERPOOL
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Credential | DMD
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Telephone | 937-903-1850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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