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General NPI Number Information
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NPI Number | 1740955186
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Entity Type | Individual
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Provider Name | BRIAN Z VAN ROOYEN DDS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 101 ROCHDALE DR S STE A
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-2273
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Country | US
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Telephone | 248-656-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 3506 E POND LN
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City | LAKE ORION
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State | MI
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Zip | 48359-1474
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Country | US
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Telephone | 248-497-4456
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901601080
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License Number State | MI
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