Healthcare Provider Details

I. General information

NPI: 1386659118
Provider Name (Legal Business Name): FRANC JJ VANDERVEN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S WADSWORTH BLVD SUITE D 211
LAKEWOOD CO
80227
US

IV. Provider business mailing address

3333 S WADSWORTH BLVD SUITE D 211
LAKEWOOD CO
80227
US

V. Phone/Fax

Practice location:
  • Phone: 303-969-9150
  • Fax:
Mailing address:
  • Phone: 303-969-9150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7078
License Number StateCO

VIII. Authorized Official

Name: FRANC JJ VANDERVEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 303-969-9150