Provider Demographics
NPI:1851727952
Name:WOODMEADOW DENTISTRY, PLLC
Entity Type:Organization
Organization Name:WOODMEADOW DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHEL
Authorized Official - Last Name:DE ZWAAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-949-3581
Mailing Address - Street 1:2554 WOODMEADOW DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8033
Mailing Address - Country:US
Mailing Address - Phone:616-949-3581
Mailing Address - Fax:616-949-2588
Practice Address - Street 1:2554 WOODMEADOW DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8033
Practice Address - Country:US
Practice Address - Phone:616-949-3581
Practice Address - Fax:616-949-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1982759916OtherPRIVATE
MI1821349549OtherPRIVATE