Provider Demographics
NPI:1114928348
Name:VANDYNE, STEPHANIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:VANDYNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2771
Mailing Address - Country:US
Mailing Address - Phone:913-367-0203
Mailing Address - Fax:913-367-5037
Practice Address - Street 1:413 S 10TH ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2771
Practice Address - Country:US
Practice Address - Phone:913-367-0203
Practice Address - Fax:913-367-5037
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS63831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16747019OtherBC/BS OF KC
KS19358OtherBC/BS
KS4054875701Medicaid
KS100225290AOtherDORAL DENTAL