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General NPI Number Information
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NPI Number | 1679592489
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Entity Type | Individual
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Provider Name | LARRY VAN AMEYDE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 51745 VAN DYKE AVE
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-4451
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Country | US
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Telephone | 586-323-1600
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Fax | 586-323-1644
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Provider Business Mailing Address
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Address Line | 51745 VAN DYKE AVE
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-4451
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Country | US
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Telephone | 586-323-1600
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Fax | 586-323-1644
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10374
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License Number State | MI
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