Provider Demographics
NPI:1639235195
Name:DEVRIES, WILLIAM E (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:597 BALDWIN DRIVE
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0047
Mailing Address - Country:US
Mailing Address - Phone:616-457-4220
Mailing Address - Fax:616-457-4024
Practice Address - Street 1:597 BALDWIN DRIVE
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49429-0047
Practice Address - Country:US
Practice Address - Phone:616-457-4220
Practice Address - Fax:616-457-4024
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI104131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics