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General NPI Number Information
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NPI Number | 1902982226
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Entity Type | Individual
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Provider Name | JOHN C VAN GINKEL DDS
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Gender | Male
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1401 AIRPORT PKWY SUITE 110
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City | CHEYENNE
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State | WY
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Zip | 82001-1518
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Country | US
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Telephone | 307-632-4574
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Fax | 307-632-4574
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Provider Business Mailing Address
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Address Line | 1401 AIRPORT PKWY SUITE 110
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City | CHEYENNE
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State | WY
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Zip | 82001-1518
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Country | US
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Telephone | 307-632-4574
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Fax | 307-632-4574
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 890
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License Number State | WY
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