Provider Demographics
NPI:1013035245
Name:VRUGGINK, SETH ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:ADAM
Last Name:VRUGGINK
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 1:15450 OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2148
Mailing Address - Country:US
Mailing Address - Phone:616-847-4044
Mailing Address - Fax:616-846-6156
Practice Address - Street 1:522 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1954
Practice Address - Country:US
Practice Address - Phone:616-846-3230
Practice Address - Fax:616-846-6156
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice