Healthcare Provider Details

I. General information

NPI: 1366671208
Provider Name (Legal Business Name): JON PETER VANDEWALKER DDS, MS, FAGD, ABGD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23370 ROAD 22
CHOWCHILLA CA
93610-8504
US

IV. Provider business mailing address

23370 ROAD 22
CHOWCHILLA CA
93610-8504
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 60056659
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number65116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: