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General NPI Number Information
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NPI Number | 1134668460
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Entity Type | Organization
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Legal Business Name | KYLE L. VONK DDS P.C.
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 2607 S. CLEVELAND AVE.
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City | ST. JOSEPH
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State | MI
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Zip | 49085
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Country | US
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Telephone | 269-428-4430
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Fax | 269-428-0037
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Provider Business Mailing Address
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Address Line | 2607 S. CLEVELAND AVE.
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City | ST. JOSEPH
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State | MI
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Zip | 49085
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Country | US
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Telephone | 269-428-4430
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Fax | 269-428-0037
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. KYLE LON VONK
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Credential | DDS
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Telephone | 269-428-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901016338
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License Number State | MI
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