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General NPI Number Information
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NPI Number | 1891235768
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Entity Type | Organization
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Legal Business Name | DR. VANDELLO FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 1047 THORNDALE AVE
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City | WATERLOO
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State | IA
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Zip | 50701-3349
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Country | US
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Telephone | 319-235-0164
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Fax |
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Provider Business Mailing Address
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Address Line | 1047 THORNDALE AVE
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City | WATERLOO
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State | IA
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Zip | 50701-3349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/GENERAL DENTIST
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Name | DR. MICHAEL VANDELLO
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Credential | D.D.S.
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Telephone | 319-235-0164
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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 | DDS09008
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License Number State | IA
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