Individual
MR. LARRY VAN AMEYDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
51745 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48316-4451
(586) 323-1600
(586) 323-1644
Mailing address
51745 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48316-4451
(586) 323-1600
(586) 323-1644
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10374
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9755011140
BLUE CROSS BLUE SHIELD ID
MI
Enumeration date
07/19/2006
Last updated
09/06/2007
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