Provider Demographics
NPI:1972131449
Name:VANDERVOORT, BRIANNA CHRISTINE FREITAG (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:CHRISTINE FREITAG
Last Name:VANDERVOORT
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 1:60 WATER ST APT 1111
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1988
Mailing Address - Country:US
Mailing Address - Phone:248-974-4503
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY RM 1004
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4213
Practice Address - Country:US
Practice Address - Phone:127-521-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY062396-011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program