# MICHAEL H. VANDERVEEN DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295862340
- **Authorized official:** DR. MICHAEL H VANDERVEEN D.D.S. (OWNER)
- **Authorized official phone:** (616) 940-0940

## Contact information

- **Practice address:** 2865 CLYDE PARK AVE SW, WYOMING, MI 49509-2911
- **Practice address phone:** (616) 940-0940
- **Mailing address:** 2865 CLYDE PARK AVE SW, WYOMING, MI 49509-2911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 11356 | MI | Yes |
| 1223G0001X | General Practice Dentistry | 18692 | MI | — |

## Other

- **Enumeration date:** 02/27/2007
- **Last updated:** 05/01/2012