Provider Demographics
NPI:1154647675
Name:VANKOOTEN, PATRICIA Y (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:Y
Last Name:VANKOOTEN
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 1:251 LIGHTHOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1416
Mailing Address - Country:US
Mailing Address - Phone:831-373-0478
Mailing Address - Fax:831-373-0137
Practice Address - Street 1:251 LIGHTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1416
Practice Address - Country:US
Practice Address - Phone:831-373-0478
Practice Address - Fax:831-373-0137
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist