Provider Demographics
NPI:1831397520
Name:VEENSTRA, ERIC D (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:VEENSTRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GODWIN AVE. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432
Mailing Address - Country:US
Mailing Address - Phone:201-447-0300
Mailing Address - Fax:201-447-1321
Practice Address - Street 1:44 GODWIN AVE. SUITE 200
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432
Practice Address - Country:US
Practice Address - Phone:201-447-0300
Practice Address - Fax:201-447-1321
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023501001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice