Provider Demographics
NPI:1578656807
Name:VAN, HOWARD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:C
Last Name:VAN
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 1:3858 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3431
Mailing Address - Country:US
Mailing Address - Phone:951-509-8828
Mailing Address - Fax:951-509-8788
Practice Address - Street 1:3858 TYLER ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3431
Practice Address - Country:US
Practice Address - Phone:951-509-8828
Practice Address - Fax:951-509-8788
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487771223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice