Provider Demographics
NPI:1114928454
Name:HOEKSTRA, CORNELIUS WILLIAM HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS WILLIAM
Middle Name:HENRY
Last Name:HOEKSTRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:12350 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9219
Mailing Address - Country:US
Mailing Address - Phone:616-738-9900
Mailing Address - Fax:616-738-3090
Practice Address - Street 1:12350 RILEY ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9219
Practice Address - Country:US
Practice Address - Phone:616-738-9900
Practice Address - Fax:616-738-3090
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2901013103204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9757060030OtherBCBS MEDICAL
MI9757060030OtherBCBS MEDICAL