Provider Demographics
NPI:1033863303
Name:VAN OOSTENDORP DDS AND VAN OOSTENDORP DMD PLLC
Entity Type:Organization
Organization Name:VAN OOSTENDORP DDS AND VAN OOSTENDORP DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN OOSTENDORP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:288-884-3702
Mailing Address - Street 1:31 HYDE PARK PL
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-0375
Mailing Address - Country:US
Mailing Address - Phone:288-884-3702
Mailing Address - Fax:
Practice Address - Street 1:230 POPLAR DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5229
Practice Address - Country:US
Practice Address - Phone:828-586-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental