Provider Demographics
NPI:1689883092
Name:BURGGRAAF, KATHRYN VERHEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:VERHEY
Last Name:BURGGRAAF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 KALAMAZOO AVE SE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-1475
Mailing Address - Country:US
Mailing Address - Phone:616-241-2659
Mailing Address - Fax:
Practice Address - Street 1:3167 KALAMAZOO AVE SE
Practice Address - Street 2:SUITE 208
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1475
Practice Address - Country:US
Practice Address - Phone:616-241-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010195801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice