Healthcare Provider Details

I. General information

NPI: 1316056989
Provider Name (Legal Business Name): DANIEL J. VANANTWERP D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HEALTH PARTNER CIRCLE
MT. ORAB OH
45154-1408
US

IV. Provider business mailing address

5400 DUPONT CIRCLE SUITE A
MILFORD OH
45150
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-2514
  • Fax: 937-444-4818
Mailing address:
  • Phone: 513-576-7700
  • Fax: 513-576-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: