Provider Demographics
NPI:1093127904
Name:VANBECK, PETER JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:VANBECK
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 1:4389 WESTPARK CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2799
Mailing Address - Country:US
Mailing Address - Phone:269-779-9797
Mailing Address - Fax:
Practice Address - Street 1:2411 OAK VALLEY DR STE 300
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7600
Practice Address - Country:US
Practice Address - Phone:734-827-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010212351223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice