Provider Demographics
NPI:1871517391
Name:VANDER BEEK, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VANDER BEEK
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 1:9182 MORNING MIST DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2880
Mailing Address - Country:US
Mailing Address - Phone:248-701-1020
Mailing Address - Fax:248-682-9266
Practice Address - Street 1:4189 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2136
Practice Address - Country:US
Practice Address - Phone:248-682-9653
Practice Address - Fax:248-682-9266
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI013671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice