Provider Demographics
NPI:1427291343
Name:VANDERMEER, TODD R (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:VANDERMEER
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 1:1869 PORTER ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-1709
Mailing Address - Country:US
Mailing Address - Phone:616-532-7601
Mailing Address - Fax:616-531-4390
Practice Address - Street 1:1869 PORTER ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-1709
Practice Address - Country:US
Practice Address - Phone:616-532-7601
Practice Address - Fax:616-531-4390
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1475401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice