Provider Demographics
NPI:1316056989
Name:VANANTWERP, DANIEL J (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:VANANTWERP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 DUPONT CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:150 HEALTH PARTNER CIRCLE
Practice Address - Street 2:
Practice Address - City:MT. ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-1408
Practice Address - Country:US
Practice Address - Phone:937-444-2514
Practice Address - Fax:937-444-4818
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041265Medicaid