Provider Demographics
NPI:1225312523
Name:ANDREW M VAN HAREN DDS PLC
Entity Type:Organization
Organization Name:ANDREW M VAN HAREN DDS PLC
Other - Org Name:VH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VAN HAREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-361-9290
Mailing Address - Street 1:2700 FIVE MILE RD,
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-361-9290
Mailing Address - Fax:
Practice Address - Street 1:2700 FIVE MILE RD,
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-361-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty