Provider Demographics
NPI:1255595344
Name:VAN HAREN, KATIE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MARIE
Last Name:VAN HAREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 5 MILE RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6516
Mailing Address - Country:US
Mailing Address - Phone:616-361-9290
Mailing Address - Fax:
Practice Address - Street 1:2700 5 MILE RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6516
Practice Address - Country:US
Practice Address - Phone:616-361-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist