Provider Demographics
NPI:1740855386
Name:PETER VANBECK DDS PLLC
Entity type:Organization
Organization Name:PETER VANBECK DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-827-2273
Mailing Address - Street 1:2411 OAK VALLEY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-7600
Mailing Address - Country:US
Mailing Address - Phone:734-827-2273
Mailing Address - Fax:734-929-9951
Practice Address - Street 1:2411 OAK VALLEY DR STE 300
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7600
Practice Address - Country:US
Practice Address - Phone:734-827-2273
Practice Address - Fax:734-929-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherNONE