Provider Demographics
NPI:1255326237
Name:VANLIEW, LOUANN B (DMD ; FAGD)
Entity Type:Individual
Prefix:DR
First Name:LOUANN
Middle Name:B
Last Name:VANLIEW
Suffix:
Gender:F
Credentials:DMD ; FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LACEY RD.
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731
Mailing Address - Country:US
Mailing Address - Phone:609-242-3567
Mailing Address - Fax:609-242-3330
Practice Address - Street 1:710 LACEY RD.
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731
Practice Address - Country:US
Practice Address - Phone:609-242-3567
Practice Address - Fax:609-242-3330
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI203941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDI20394OtherNJ DENTAL LICENSE