Provider Demographics
NPI:1144480583
Name:VANDORN, BELINDA (RDHAP)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:VANDORN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:
Other - Last Name:VAN DORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDHAP
Mailing Address - Street 1:PO BOX 3217
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-8317
Mailing Address - Country:US
Mailing Address - Phone:310-402-8549
Mailing Address - Fax:
Practice Address - Street 1:915 PEPPER ST APT 1
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2376
Practice Address - Country:US
Practice Address - Phone:310-402-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist