Provider Demographics
NPI:1871698209
Name:VAN EREM, KAY A (DDS)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:A
Last Name:VAN EREM
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 1:115 WEST CENTURY AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503
Mailing Address - Country:US
Mailing Address - Phone:701-222-8229
Mailing Address - Fax:701-258-7824
Practice Address - Street 1:115 WEST CENTURY AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503
Practice Address - Country:US
Practice Address - Phone:701-222-8229
Practice Address - Fax:701-258-7824
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41005Medicaid