Provider Demographics
NPI:1023238334
Name:VANGREUNINGEN, VICTOR DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:DANIEL
Last Name:VANGREUNINGEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4294 KINGSTON GATE CV
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1041
Mailing Address - Country:US
Mailing Address - Phone:770-454-0510
Mailing Address - Fax:
Practice Address - Street 1:4294 KINGSTON GATE CV
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1041
Practice Address - Country:US
Practice Address - Phone:770-454-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice