Provider Demographics
NPI:1770652588
Name:VANDENHOVEN, PETER E (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:VANDENHOVEN
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:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-0307
Mailing Address - Country:US
Mailing Address - Phone:707-965-2479
Mailing Address - Fax:
Practice Address - Street 1:41 ANGWIN PLAZA
Practice Address - Street 2:
Practice Address - City:ANGWIN
Practice Address - State:CA
Practice Address - Zip Code:94508
Practice Address - Country:US
Practice Address - Phone:707-965-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice