Dyan Marie Vandevelde, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

29512 Issued in CA

Practice address

2325 Palos Verdes Dr W Ste 210
Palos Verdes Estates, CA 90274-2787

Phone

(310) 377-6580

Fax

(310) 377-3838

NPI assigned

May 31, 2011

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

Other names 1

• Mrs. Dyan Van de Velde Poucher Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

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": "1306800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463011200000",
    "number": "1871887497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 PALOS VERDES DR W STE 210",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902742787",
            "telephone_number": "310-377-6580",
            "fax_number": "310-377-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 PALOS VERDES DR W STE 210",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902742787",
            "telephone_number": "310-377-6580",
            "fax_number": "310-377-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVELDE",
        "first_name": "DYAN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-31",
        "last_updated": "2016-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "29512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DYAN",
            "last_name": "POUCHER",
            "middle_name": "VAN DE VELDE",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• General Practice Dentistry in Palos Verdes Estates, CA
• Providers in Palos Verdes Estates, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; 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.