Provider Demographics
NPI:1063646289
Name:VANGRINSVEN, GARY ALBERT (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALBERT
Last Name:VANGRINSVEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25228 SUMMERHILL LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-2261
Mailing Address - Country:US
Mailing Address - Phone:661-254-0697
Mailing Address - Fax:661-254-0697
Practice Address - Street 1:23734 VALENCIA BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2100
Practice Address - Country:US
Practice Address - Phone:661-253-2200
Practice Address - Fax:661-253-2220
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice