MEDICARE: DALE L. VANDERSCHELDEN DDS PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083962187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALE L. VANDERSCHELDEN DDS PS

Provider Business Mailing Address
First Line	:	18209 SR 410 E
Second Line	:	STE 300
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-5146
Country	:	US
Telephone Number	:	253-826-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	18209 SR 410 E
Second Line	:	STE 300
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-5146
Country	:	US
Telephone Number	:	253-826-8800
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ASST
Name	:	NICOLE REMINGTON
Credential	:
Telephone Number	:	253-826-8800

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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