Healthcare Provider Details

I. General information

NPI: 1821349549
Provider Name (Legal Business Name): ANDREW MICHEL DE ZWAAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 3 MILE RD NW STE 110
GRAND RAPIDS MI
49544-1673
US

IV. Provider business mailing address

933 3 MILE RD NW STE 110
GRAND RAPIDS MI
49544-1673
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-6300
  • Fax:
Mailing address:
  • Phone: 616-784-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020721
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: