MEDICARE: CHRISTIAN VERMEULEN DDS PLC

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	122300000X	Dentist	29001018102	MI

General Provider Information

NPI Number	:	1396869020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN VERMEULEN DDS PLC

Provider Business Mailing Address
First Line	:	4940 CASCADE RD SE STE 010
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3723
Country	:	US
Telephone Number	:	616-949-3500
Fax Number	:	616-949-9931

Provider Business Practice Location Address
First Line	:	4940 CASCADE RD SE STE 010
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3723
Country	:	US
Telephone Number	:	616-949-3500
Fax Number	:	616-949-9931

Authorized Official
Title or Position	:	DENTIST PRESIDENT
Name	:	DR. CHRISTIAN L VERMEULEN
Credential	:	DDS
Telephone Number	:	616-949-3500

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

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