Organization
L VAN AMEYDE DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY VAN AMEYDE (ORAL SURGEON)
(586) 323-1600
Entity
Organization
Contact information
Practice address
51745 VAN DYKE, SHELBY TWP, MI 48316
(586) 323-1600
(586) 323-1644
Mailing address
51745 VAN DYKE, SHELBY TWP, MI 48316
(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
BCBS ID #
MI
Enumeration date
01/31/2008
Last updated
01/31/2008
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