Provider Demographics
NPI:1225203714
Name:ROEDEMA, WILLIAM H (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:ROEDEMA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 BASSWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2003
Mailing Address - Country:US
Mailing Address - Phone:616-531-6377
Mailing Address - Fax:
Practice Address - Street 1:3739 BASSWOOD DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2003
Practice Address - Country:US
Practice Address - Phone:616-531-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010096461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics