Provider Demographics
NPI:1295396745
Name:VAN DER WERF, ANNIKA (DDS)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
Last Name:VAN DER WERF
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 1:1055 17TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2647
Mailing Address - Country:US
Mailing Address - Phone:303-678-5253
Mailing Address - Fax:
Practice Address - Street 1:13533 HURON ST STE 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1160
Practice Address - Country:US
Practice Address - Phone:303-450-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002049261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics