Healthcare Provider Details

I. General information

NPI: 1174667950
Provider Name (Legal Business Name): DAVID J. HUYSER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-6045
US

IV. Provider business mailing address

890 WASHINGTON AVE SUITE 110
HOLLAND MI
49423-7731
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-0909
  • Fax: 616-957-9887
Mailing address:
  • Phone: 616-355-7930
  • Fax: 616-355-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901013469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: