MEDICARE: KYLE L. VONK DDS P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901016338	MI

General Provider Information

NPI Number	:	1134668460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYLE L. VONK DDS P.C.

Provider Business Mailing Address
First Line	:	2607 S. CLEVELAND AVE.
Second Line	:
City	:	ST. JOSEPH
State	:	MI
Zip	:	49085
Country	:	US
Telephone Number	:	269-428-4430
Fax Number	:	269-428-0037

Provider Business Practice Location Address
First Line	:	2607 S. CLEVELAND AVE.
Second Line	:
City	:	ST. JOSEPH
State	:	MI
Zip	:	49085
Country	:	US
Telephone Number	:	269-428-4430
Fax Number	:	269-428-0037

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. KYLE LON VONK
Credential	:	DDS
Telephone Number	:	269-428-4430

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	02/20/2017

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