1174515498 NPI number — DR. DONALD CRAIG TIGCHELAAR D.D.S.

Table of content: DR. DONALD CRAIG TIGCHELAAR D.D.S. (NPI 1174515498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174515498 NPI number — DR. DONALD CRAIG TIGCHELAAR D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIGCHELAAR
Provider First Name:
DONALD
Provider Middle Name:
CRAIG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174515498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 SUMMIT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47842-7363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-312-8559
Provider Business Mailing Address Fax Number:
765-828-1337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 E MAIN ST
Provider Second Line Business Practice Location Address:
VA ILLIANA HEALTHCARE SYSTEM
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-554-4516
Provider Business Practice Location Address Fax Number:
217-554-4881
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN0013899 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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