Healthcare Provider Details

I. General information

NPI: 1477503191
Provider Name (Legal Business Name): BRIAN J BUURMA D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 NORTH WELLNESS DRIVE SUITE 270
HOLLAND MI
49424
US

IV. Provider business mailing address

3290 N WELLNESS DR SUITE 270
HOLLAND MI
49424-7259
US

V. Phone/Fax

Practice location:
  • Phone: 616-994-9722
  • Fax: 616-994-9733
Mailing address:
  • Phone: 616-994-6050
  • Fax: 616-994-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901017574
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: