Provider Demographics
NPI:1902418742
Name:VAN HOOREBEKE, CLAIRE ELISABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:ELISABETH
Last Name:VAN HOOREBEKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 N WYNDHAM RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-5501
Mailing Address - Country:US
Mailing Address - Phone:760-521-7634
Mailing Address - Fax:
Practice Address - Street 1:3151 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1312
Practice Address - Country:US
Practice Address - Phone:316-272-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS617111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty