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General NPI Number Information
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NPI Number | 1821537010
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Entity Type | Organization
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Legal Business Name | MARSHALL FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 207 WINSTON DR
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City | MARSHALL
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State | MI
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Zip | 49068-8526
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Country | US
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Telephone | 269-781-6300
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Fax | 269-781-8459
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Provider Business Mailing Address
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Address Line | 207 WINSTON DR
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City | MARSHALL
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State | MI
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Zip | 49068-8526
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Country | US
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Telephone | 269-781-6300
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Fax | 269-781-8459
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS ALAN VANDERMEULEN
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Credential | DDS
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Telephone | 269-781-6300
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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 | 13841
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License Number State | MI
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