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Provider Information for 1871887497

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. DYAN MARIE VANDEVELDE DMD

Other Name:   DYAN POUCHER
Gender: FEMALE

Individual NPI: 1871887497

Calendar   Last Updated:  2016-05-12
  Certification Date: 

Details

Name Value
NPI 1871887497
Enumeration Date 2011-05-31
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2325 PALOS VERDES DR W STE 210
PALOS VERDES ESTATES, CA 90274-2787
United States

Phone: 310-377-6580 | Fax: 310-377-3838
View Map External Link
Primary Practice Address 2325 PALOS VERDES DR W STE 210
PALOS VERDES ESTATES, CA 90274-2787
United States

Phone: 310-377-6580 | Fax: 310-377-3838
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 29512