Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D13527 | MI |
NPI | 1023163136 |
---|---|
Provider Name | Dr. Paul Vanraaphorst |
First Address | Rochester Hills, MI 48307-2584 |
Second Address | Rochester Hills, MI 48307-2584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |