Active NPI
Craig A Vandongen, DDS
- Prosthodontics
- Providence, RI
National Provider Identifier
1558584656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- DEN02334
- Practice address
- 372 Ives St
Providence, RI 02906-3929 - Phone
- (401) 831-3777
- NPI assigned
- Apr 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | DEN02334 | RI | Primary |
Addresses
Primary practice location
372 Ives St
Providence, RI 02906-3929
Mailing address
50 Moosehorn Rd
East Greenwich, RI 02818-1112
Phone (401) 886-9955
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 21, 2016 through Apr 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN02334 | RI | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558584656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 MOOSEHORN RD",
"city": "EAST GREENWICH",
"state": "RI",
"postal_code": "028181112",
"telephone_number": "401-886-9955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "372 IVES ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029063929",
"telephone_number": "401-831-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDONGEN",
"first_name": "CRAIG",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "RI",
"license": "DEN02334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.