Provider Demographics
NPI:1497979090
Name:VAN ZYL, CRAIG M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:M
Last Name:VAN ZYL
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 1:119 N EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1501
Mailing Address - Country:US
Mailing Address - Phone:269-781-2336
Mailing Address - Fax:
Practice Address - Street 1:119 N EAGLE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1501
Practice Address - Country:US
Practice Address - Phone:269-781-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016507122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist