Provider Demographics
NPI:1376636092
Name:VAN DYKE, KAREN PATRICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:PATRICIA
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:K. TRISH
Other - Middle Name:
Other - Last Name:VAN DYKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:20615 COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013
Mailing Address - Country:US
Mailing Address - Phone:530-335-3521
Mailing Address - Fax:530-335-5558
Practice Address - Street 1:20615 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013
Practice Address - Country:US
Practice Address - Phone:530-335-3521
Practice Address - Fax:530-335-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37301-02OtherHEALTY FAMILIES