Individual
JOHN VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
55 E BROADWAY RD, TEMPE, AZ 85282-1302
(480) 374-1872
Mailing address
55 E BROADWAY RD, TEMPE, AZ 85282-1302
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
60614
CA
1223G0001X
General Practice Dentistry
Primary
D008280
AZ
Other
Enumeration date
08/22/2011
Last updated
08/22/2011
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