MEDICARE: DR. FRANC JJ VANDERVEN DMD

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
1	1223P0300X	Periodontics	7078	CO

General Provider Information

NPI Number	:	1831315936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANC JJ VANDERVEN DMD

Provider Business Mailing Address
First Line	:	3333 S WADSWORTH BLVD
Second Line	:	SUITE D211
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5122
Country	:	US
Telephone Number	:	303-969-9150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 S WADSWORTH BLVD
Second Line	:	SUITE D211
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5122
Country	:	US
Telephone Number	:	303-969-9150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	10/22/2013

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