Provider Demographics
NPI:1588127021
Name:ETTIENNE R VAN ZYL, DDS, PLLC
Entity type:Organization
Organization Name:ETTIENNE R VAN ZYL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETTIENNE
Authorized Official - Middle Name:REINHARDT
Authorized Official - Last Name:VAN ZYL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-372-4500
Mailing Address - Street 1:701 S HORSEBARN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8796
Mailing Address - Country:US
Mailing Address - Phone:479-372-4500
Mailing Address - Fax:479-372-4525
Practice Address - Street 1:701 S HORSEBARN RD STE 102
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8796
Practice Address - Country:US
Practice Address - Phone:479-372-4500
Practice Address - Fax:479-372-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental