Active NPI
Michelle Marie Vanderwal, RDH
- Dental Hygienist
- Tyndall Afb, FL
National Provider Identifier
1770634321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH 18089
- Practice address
- 340 Magnolia Cir
BLDG 1465
Tyndall Afb, FL 32403-5604 - Phone
- (850) 283-7574
- NPI assigned
- Jan 12, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH 18089 | FL | Primary |
Addresses
Primary practice location
340 Magnolia Cir
BLDG 1465
Tyndall Afb, FL 32403-5604
Mailing address
926 Lee CT
Panama City, FL 32404-9661
Phone (850) 215-7585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DH 18089 | FL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770634321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "926 LEE CT",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324049661",
"telephone_number": "850-215-7585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 MAGNOLIA CIR",
"address_2": "BLDG 1465",
"city": "TYNDALL AFB",
"state": "FL",
"postal_code": "324035604",
"telephone_number": "850-283-7574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERWAL",
"first_name": "MICHELLE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "FL",
"license": "DH 18089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyndall Afb, FL
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.