Taryn Mashelle Vangerpen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60658473 Issued in WA

Practice address

1019 112TH St SW
Everett, WA 98204-4875

Phone

(425) 551-6200

NPI assigned

Feb 22, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1720527898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 112TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982044875",
            "telephone_number": "425-551-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 112TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982044875",
            "telephone_number": "425-551-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "602 E Nob Hill Blvd",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989013534",
            "country_code": "US",
            "telephone_number": "509-248-1082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANGERPEN",
        "first_name": "TARYN",
        "middle_name": "MASHELLE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-22",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60658473",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60658473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jade McKern Vanderwood, BA, AAC
• Joseph Andrew Vanderwood
• John C Vandree, MD
• Levi Vandyke
• Sophie Anne Vanessen
• Amanda Ellen Vangordon
• Timothy Vanoss, CPO
• Shazia Vanputten, LMFT
• Kaleb James Vanrijswijck, BA, CPC
• Robert E Vanvalkenburgh

• General Practice Dentistry in Everett, WA
• Providers in Everett, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.