Provider Demographics
NPI:1992821862
Name:MICHAEL VANDENBERG, D.D.S., P.A.
Entity type:Organization
Organization Name:MICHAEL VANDENBERG, D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:VANDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-888-6220
Mailing Address - Street 1:9226 PFLUMM RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3346
Mailing Address - Country:US
Mailing Address - Phone:913-888-6220
Mailing Address - Fax:913-888-8464
Practice Address - Street 1:9226 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3346
Practice Address - Country:US
Practice Address - Phone:913-888-6220
Practice Address - Fax:913-888-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1376561704OtherINDIVIDUAL NPI NUMBER