Raymond McReady Travis Vanderwerf, DDS, CAGS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

2117 Issued in AZ

Practice address

1630 S Stapley Dr
#208
Mesa, AZ 85204-6657

Phone

(480) 775-2656

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013126101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 S STAPLEY DR",
            "address_2": "#208",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046657",
            "telephone_number": "480-775-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 S STAPLEY DR",
            "address_2": "#208",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046657",
            "telephone_number": "480-775-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWERF",
        "first_name": "RAYMOND",
        "middle_name": "MCREADY TRAVIS",
        "name_prefix": "Dr.",
        "credential": "DDS, CAGS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "AZ",
            "license": "2117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cristin Vandenburgh
• Nancy L Vander Veer, PSYD
• Symen Vanderlinden Jr., DMD
• Tatum Vanderpool
• Sarah Vandervliet
• Michael Ross Vanhara
• Karen Vanhelden, M.T.
• Chris A Vanhove, RPH
• Stephen Vann, D.D.S.
• Scott E Vanskike, NP-C

• Endodontics in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Endodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.