Provider Demographics
NPI:1740955186
Name:VAN ROOYEN, BRIAN Z (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:Z
Last Name:VAN ROOYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 E POND LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1474
Mailing Address - Country:US
Mailing Address - Phone:248-497-4456
Mailing Address - Fax:
Practice Address - Street 1:101 ROCHDALE DR S STE A
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2273
Practice Address - Country:US
Practice Address - Phone:248-656-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty