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General NPI Number Information
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NPI Number | 1831222454
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Entity Type | Individual
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Provider Name | MICHELLE L VANDYKE DDS
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1124 28TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-2855
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Country | US
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Telephone | 616-530-9900
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Fax | 616-656-5765
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Provider Business Mailing Address
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Address Line | 609 FOWLER ST
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City | MUSKEGON
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State | MI
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Zip | 49445-3059
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Country | US
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Telephone | 231-286-8114
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901018623
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License Number State | MI
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