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CHARLES EDWIN VANDIVER DDS

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1508884628

Individual Registrant:
 CHARLES EDWIN VANDIVER DDS
Gender: M
Sole Proprietor

Location and contact information for practice:
660 7TH ST.  MEEKER, CO 81641-1008 US
Tel: 970-878-5853  Fax: 970-878-4560

Contact information for business:
PO BOX 1008  MEEKER, CO 81641-1008 US
Tel: 970-878-5853  Fax: 970-878-4560

Registration Information:
NPI: 1508884628
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
CO00134

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
02001345CO05




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