Provider Demographics
NPI:1023163136
Name:VANRAAPHORST, PAUL (DDS, MS, PC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:VANRAAPHORST
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 S LIVERNOIS RD
Mailing Address - Street 2:SUITE #280
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2584
Mailing Address - Country:US
Mailing Address - Phone:248-656-3200
Mailing Address - Fax:248-656-7169
Practice Address - Street 1:441 S LIVERNOIS RD
Practice Address - Street 2:SUITE 280
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2584
Practice Address - Country:US
Practice Address - Phone:248-656-3200
Practice Address - Fax:248-656-7169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID135271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics