Provider Demographics
NPI:1609003987
Name:VANDERLAAN, MATTHEW RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:VANDERLAAN
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 1:820 84TH STREET SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9458
Mailing Address - Country:US
Mailing Address - Phone:616-455-7310
Mailing Address - Fax:616-455-0332
Practice Address - Street 1:820 84TH STREET SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9458
Practice Address - Country:US
Practice Address - Phone:616-455-7310
Practice Address - Fax:616-455-0332
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010200141223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice