Provider Demographics
NPI:1093924508
Name:VANSPEYBROECK, RHONDA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:LYNN
Last Name:VANSPEYBROECK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7169
Mailing Address - Country:US
Mailing Address - Phone:309-764-7631
Mailing Address - Fax:309-764-7635
Practice Address - Street 1:850 36TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7169
Practice Address - Country:US
Practice Address - Phone:309-764-7631
Practice Address - Fax:309-764-7635
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice