Individual
DR. KENT VANDEHAAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
123 W WILLOW ST, CHIPPEWA FALLS, WI 54729-2329
(715) 723-5688
(715) 723-4039
Mailing address
123 W WILLOW ST, CHIPPEWA FALLS, WI 54729-2329
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2836
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33432500
—
WI
Enumeration date
05/23/2007
Last updated
07/09/2007
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