Provider Demographics
NPI:1972717833
Name:VANVENROOY, ERIC ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALLEN
Last Name:VANVENROOY
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 686
Mailing Address - Street 2:
Mailing Address - City:CECILTON
Mailing Address - State:MD
Mailing Address - Zip Code:21913-0686
Mailing Address - Country:US
Mailing Address - Phone:410-275-1462
Mailing Address - Fax:410-275-1463
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CECILTON
Practice Address - State:MD
Practice Address - Zip Code:21913-1142
Practice Address - Country:US
Practice Address - Phone:410-275-1462
Practice Address - Fax:410-275-1463
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice