Individual
DR. DAN J VANDERMEULEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
8191 MOORSBRIDGE ROAD, SUITE A, PORTAGE, MI 49024
(269) 323-1022
(269) 323-0702
Mailing address
801 FAIRVIEW, RICHLAND, MI 49083
(269) 629-9465
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
10199
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1953960010
BCBS OF MI FOR MED CLAIMS
MI
Enumeration date
08/18/2006
Last updated
07/08/2007
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