Provider Demographics
NPI:1508925710
Name:VANHOOSE, JULIE RUTH (DMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:RUTH
Last Name:VANHOOSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:RUTH
Other - Last Name:NAMANWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2545 EAST PARIS SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6134
Mailing Address - Country:US
Mailing Address - Phone:616-942-4750
Mailing Address - Fax:616-942-5433
Practice Address - Street 1:2545 EAST PARIS SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6134
Practice Address - Country:US
Practice Address - Phone:616-942-4750
Practice Address - Fax:616-942-5433
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist