Provider Demographics
NPI:1760535512
Name:ZUIDERVEEN, CRISTIN LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRISTIN
Middle Name:LOUISE
Last Name:ZUIDERVEEN
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 1:1864 GEORGETOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7137
Mailing Address - Country:US
Mailing Address - Phone:616-457-9191
Mailing Address - Fax:
Practice Address - Street 1:1864 GEORGETOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-7137
Practice Address - Country:US
Practice Address - Phone:616-457-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice