Provider Demographics
NPI:1053424861
Name:VAN DE LINDER, WILLIAM RUSSELL (DDS,)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:VAN DE LINDER
Suffix:
Gender:M
Credentials:DDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12553 HIGHWAY 69 N
Mailing Address - Street 2:POB 370
Mailing Address - City:ADAIR
Mailing Address - State:OK
Mailing Address - Zip Code:74330-2820
Mailing Address - Country:US
Mailing Address - Phone:918-785-4399
Mailing Address - Fax:
Practice Address - Street 1:12553 HIGHWAY 69 N
Practice Address - Street 2:POB 370
Practice Address - City:ADAIR
Practice Address - State:OK
Practice Address - Zip Code:74330-2820
Practice Address - Country:US
Practice Address - Phone:918-785-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice