Provider Demographics
NPI:1295425635
Name:VAN DRUNEN, ALICIA JADE (DDS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JADE
Last Name:VAN DRUNEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8947 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1483
Mailing Address - Country:US
Mailing Address - Phone:586-246-9045
Mailing Address - Fax:
Practice Address - Street 1:2610 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4000
Practice Address - Country:US
Practice Address - Phone:614-794-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist