Provider Demographics
NPI:1205856713
Name:VANCIL, DALE HERBERT (D P, M)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:HERBERT
Last Name:VANCIL
Suffix:
Gender:M
Credentials:D P, M
Other - Prefix:DR
Other - First Name:DALE
Other - Middle Name:HERBERT
Other - Last Name:VANCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3485 WILLOW LAKE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5152
Mailing Address - Country:US
Mailing Address - Phone:651-765-8200
Mailing Address - Fax:651-765-8201
Practice Address - Street 1:3485 WILLOW LAKE BLVD.
Practice Address - Street 2:SUITE 300
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55110-5152
Practice Address - Country:US
Practice Address - Phone:651-765-8200
Practice Address - Fax:651-765-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN338213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery