Provider Demographics
NPI:1356448377
Name:VAN OPIJNEN, WILLEM SIMON CHRISTIAAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLEM
Middle Name:SIMON CHRISTIAAN
Last Name:VAN OPIJNEN
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 1:445 ELM ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-3403
Mailing Address - Country:US
Mailing Address - Phone:530-527-2877
Mailing Address - Fax:530-527-2848
Practice Address - Street 1:445 ELM ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3403
Practice Address - Country:US
Practice Address - Phone:530-527-2877
Practice Address - Fax:530-527-2848
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADP0371781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice