Rebecca Anne Vander Baan

Primary specialty

DentistTaxonomy code 122300000X

License

2901019617 Issued in MI

Practice address

6161 Orchard Lake
Ste 201 Great Expressions Dental Centers
West Bloomfield, MI 48322

Phone

(248) 851-4915

Fax

(248) 851-5466

NPI assigned

Jun 19, 2007

Sex

Female

Sole proprietor

No

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

Enrolled in MI

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": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770788838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E LONG LAKE RD",
            "address_2": "STE 311",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "48304",
            "telephone_number": "248-203-1119",
            "fax_number": "248-723-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 ORCHARD LAKE",
            "address_2": "STE 201 GREAT EXPRESSIONS DENTAL CENTERS",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "48322",
            "telephone_number": "248-851-4915",
            "fax_number": "248-851-5466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER BAAN",
        "first_name": "REBECCA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine E Urban
• Kyle A Utterbeck
• Rachel Andis Valley, PA-C
• Aiden Andru Vance
• Demi M Vance, BEHAVIOR TECHNICIAN
• Sharon Vantuyl
• Sal M. Varano, M.D.
• Martha Lynn Vargovich, M.D.
• Carolyn Elizabeth Varner, PT
• Molly Rae Varon, OTR/L

• Dentist in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Dentist in Michigan

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.