Provider Demographics
NPI:1558473686
Name:VANBEUKERING, MICHAEL ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:VANBEUKERING
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 1:1900 CRESTWOOD BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2034
Mailing Address - Country:US
Mailing Address - Phone:205-271-6851
Mailing Address - Fax:
Practice Address - Street 1:3700 BLUE SPRING RD NW STE F
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3457
Practice Address - Country:US
Practice Address - Phone:256-852-9994
Practice Address - Fax:256-852-7797
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130751223G0001X
AL49851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA306805203AMedicaid
AL009933948Medicaid
AL009930105Medicaid