Provider Demographics
NPI:1881944585
Name:VAN EENENAAM, WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VAN EENENAAM
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 1:5901 WESTHEIMER RD STE D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7607
Mailing Address - Country:US
Mailing Address - Phone:713-228-3384
Mailing Address - Fax:713-953-7115
Practice Address - Street 1:5901 WESTHEIMER RD STE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7607
Practice Address - Country:US
Practice Address - Phone:713-228-3384
Practice Address - Fax:713-953-7115
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist