Provider Demographics
NPI:1639249154
Name:VANDEVEN, CHRISTOPHER EVERETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EVERETT
Last Name:VANDEVEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2000 43RD ST SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8700
Mailing Address - Country:US
Mailing Address - Phone:616-455-1301
Mailing Address - Fax:616-455-6533
Practice Address - Street 1:2000 43RD ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-8700
Practice Address - Country:US
Practice Address - Phone:616-455-1301
Practice Address - Fax:616-455-6533
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010192991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry