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General NPI Number Information
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NPI Number | 1497572754
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Entity Type | Individual
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Provider Name | ERIN ELIZABETH VANDENBOS RDH
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Gender | Female
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 781 36TH ST SE STE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49548-2319
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Country | US
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Telephone | 606-828-0052
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 CANNON ST SW
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City | WYOMING
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State | MI
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Zip | 49519-4208
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Country | US
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Telephone | 606-690-0609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902010581
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License Number State | MI
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