Provider Demographics
NPI:1316166044
Name:VANDERSCHELDEN, DALE L (DDS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:L
Last Name:VANDERSCHELDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18209 STATE ROUTE 410 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-5146
Mailing Address - Country:US
Mailing Address - Phone:253-826-8800
Mailing Address - Fax:253-447-2203
Practice Address - Street 1:18209 STATE ROUTE 410 E
Practice Address - Street 2:SUITE 300
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-5146
Practice Address - Country:US
Practice Address - Phone:253-826-8800
Practice Address - Fax:253-447-2203
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA56291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice