Provider Demographics
NPI:1134668460
Name:KYLE L. VONK DDS P.C.
Entity Type:Organization
Organization Name:KYLE L. VONK DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LON
Authorized Official - Last Name:VONK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-428-4430
Mailing Address - Street 1:2607 S. CLEVELAND AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-428-4430
Mailing Address - Fax:269-428-0037
Practice Address - Street 1:2607 S. CLEVELAND AVE.
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-428-4430
Practice Address - Fax:269-428-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016338122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty