MEDICARE: DR. DALE L VANDERSCHELDEN DDS

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	5629	WA

General Provider Information

NPI Number	:	1316166044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE L VANDERSCHELDEN DDS

Provider Business Mailing Address
First Line	:	18209 STATE ROUTE 410 E
Second Line	:	SUITE 300
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-5146
Country	:	US
Telephone Number	:	253-826-8800
Fax Number	:	253-447-2203

Provider Business Practice Location Address
First Line	:	18209 STATE ROUTE 410 E
Second Line	:	SUITE 300
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-5146
Country	:	US
Telephone Number	:	253-826-8800
Fax Number	:	253-447-2203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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