Healthcare Provider Details

I. General information

NPI: 1902005143
Provider Name (Legal Business Name): VALLEAU AND VANDEVEN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 43RD ST SE SUITE B
GRAND RAPIDS MI
49508-8700
US

IV. Provider business mailing address

2000 43RD ST SE SUITE B
GRAND RAPIDS MI
49508-8700
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-1301
  • Fax: 616-455-6533
Mailing address:
  • Phone: 616-455-1301
  • Fax: 616-455-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901016883
License Number StateMI

VIII. Authorized Official

Name: DR. AIMEE CHRISTINE VALLEAU
Title or Position: PRESIDENT
Credential: DDS
Phone: 616-455-1301