Robert Bruce Vandragt, DENTIST

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901011357 Issued in MI

Practice address

431 Munson Ave
Suite F
Traverse City, MI 49686-3060

Phone

(231) 946-2160

Fax

(231) 946-2161

NPI assigned

Feb 5, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1649319161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 MUNSON AVE",
            "address_2": "SUITE F",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863060",
            "telephone_number": "231-946-2160",
            "fax_number": "231-946-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 MUNSON AVE",
            "address_2": "SUITE F",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863060",
            "telephone_number": "231-946-2160",
            "fax_number": "231-946-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDRAGT",
        "first_name": "ROBERT",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "DENTIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901011357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4040757",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Vanderkaay, PA
• Kristen Nicole Vanderkolk, LPC, NCC
• Michael Homer Vanderkolk, M.D.
• Brianna Vanderley
• Corey R Vanderwulp, OT
• Audrey Vang
• Reagab Vanhaaran
• Joshua Charles Vanhorn, DDS
• Russell Neil Vanhouzen, M.D.
• Kaitlyn Joyce Vanias, M.D.

• General Practice Dentistry in Traverse City, MI
• Providers in Traverse City, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.