Provider Demographics
NPI:1861534166
Name:VANESSEN, ROBERT DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:VANESSEN
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 1:3427 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1405
Mailing Address - Country:US
Mailing Address - Phone:616-669-9205
Mailing Address - Fax:616-669-9739
Practice Address - Street 1:3427 KELLY ST
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1405
Practice Address - Country:US
Practice Address - Phone:616-669-9205
Practice Address - Fax:616-669-9739
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0142231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice