Provider Demographics
NPI:1689082810
Name:VAN WYK, AARON PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:PAUL
Last Name:VAN WYK
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 1:220 E ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6027
Mailing Address - Country:US
Mailing Address - Phone:303-772-1906
Mailing Address - Fax:
Practice Address - Street 1:203 S ROLLIE AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1508
Practice Address - Country:US
Practice Address - Phone:303-286-4560
Practice Address - Fax:303-286-4589
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist