Healthcare Provider Details

I. General information

NPI: 1770652588
Provider Name (Legal Business Name): PETER E VANDENHOVEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 ANGWIN PLAZA
ANGWIN CA
94508
US

IV. Provider business mailing address

PO BOX 307
ANGWIN CA
94508-0307
US

V. Phone/Fax

Practice location:
  • Phone: 707-965-2479
  • Fax:
Mailing address:
  • Phone: 707-965-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: