Provider Demographics
NPI:1154872331
Name:VEENSTRA FAMILY DENTAL
Entity type:Organization
Organization Name:VEENSTRA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VEENSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-790-6003
Mailing Address - Street 1:44 GODWIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1969
Mailing Address - Country:US
Mailing Address - Phone:201-447-0300
Mailing Address - Fax:
Practice Address - Street 1:44 GODWIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1969
Practice Address - Country:US
Practice Address - Phone:201-447-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI23501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty