Provider Demographics
NPI:1225241011
Name:VANSCOYOC, JOHN PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:VANSCOYOC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N HERSHEY RD
Mailing Address - Street 2:SUITE2
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3730
Mailing Address - Country:US
Mailing Address - Phone:309-664-0570
Mailing Address - Fax:309-664-6612
Practice Address - Street 1:908 N HERSHEY RD
Practice Address - Street 2:SUITE2
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3730
Practice Address - Country:US
Practice Address - Phone:309-664-0570
Practice Address - Fax:309-664-6612
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-236141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL19-23614OtherDENTAL LICENSE NUMBER