Provider Demographics
NPI:1811463730
Name:RYAN C. VAN HAREN, DDS PLLC
Entity type:Organization
Organization Name:RYAN C. VAN HAREN, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HAREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-949-2941
Mailing Address - Street 1:2144 E PARIS AVE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6111
Mailing Address - Country:US
Mailing Address - Phone:616-949-2941
Mailing Address - Fax:
Practice Address - Street 1:2144 E PARIS AVE SE STE 110
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6111
Practice Address - Country:US
Practice Address - Phone:616-949-2941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty