Provider Demographics
NPI:1427307511
Name:DEHAAN, DAVID ANDREW (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:DEHAAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 S. BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359
Mailing Address - Country:US
Mailing Address - Phone:248-391-4477
Mailing Address - Fax:248-391-4442
Practice Address - Street 1:3027 S. BALDWIN RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359
Practice Address - Country:US
Practice Address - Phone:248-391-4477
Practice Address - Fax:248-391-4442
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI202021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics