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NPI Code Detail

MEDICARE: DR. MATTHEW VEENSTRA D.D.S.

MEDICARE: DR. MATTHEW VEENSTRA D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2901021433MI

General Provider Information

NPI Number : 1477854222
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW VEENSTRA D.D.S.
Provider Business Mailing Address
First Line : 800 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-3881
Country : US
Telephone Number : 269-849-8251
Fax Number :
Provider Business Practice Location Address
First Line : 800 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-3881
Country : US
Telephone Number : 269-849-8251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2010
Last Update Date : 09/02/2025

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