Richard C Vandiver, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4538 Issued in LA

Practice address

1625 David Raines Rd
Shreveport, LA 71107-5899

Phone

(318) 841-6048

Fax

(318) 841-6044

NPI assigned

Feb 20, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: richard.vandiverdds.p1@direct.davidraineschc.nextgenshare.com

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1932243094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 E BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "UNIT #3",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055314",
            "telephone_number": "318-349-1909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 DAVID RAINES RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711075899",
            "telephone_number": "318-841-6048",
            "fax_number": "318-841-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDIVER",
        "first_name": "RICHARD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "4538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS #",
            "identifier": "20409",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD LICENSE",
            "identifier": "4538",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Vanderberg
• Robert H. Vanderberg, MD
• Catherine Florence Vanderloos, MD
• David Theodore Vandermolen, M.D.
• Brenda Lea Vanderpool, MA LPC, LMHP
• Loren Vandrovec
• Robert A Vanlangendonck
• Russell H Vannorman III, M.D.
• Jessica Vanschuyver
• Angela M Vanwright

• General Practice Dentistry in Shreveport, LA
• Providers in Shreveport, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.