Provider Demographics
NPI:1174515498
Name:TIGCHELAAR, DONALD CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CRAIG
Last Name:TIGCHELAAR
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 1:24 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-7363
Mailing Address - Country:US
Mailing Address - Phone:561-312-8559
Mailing Address - Fax:765-828-1337
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:VA ILLIANA HEALTHCARE SYSTEM
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-4516
Practice Address - Fax:217-554-4881
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist