Provider Demographics
NPI:1558484279
Name:VANDYKE, WILLIAM KELSEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KELSEY
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 W NEWBERRY RD
Mailing Address - Street 2:ST. 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2200
Mailing Address - Country:US
Mailing Address - Phone:352-377-1781
Mailing Address - Fax:352-373-2778
Practice Address - Street 1:4960 W NEWBERRY RD
Practice Address - Street 2:ST. 200
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2200
Practice Address - Country:US
Practice Address - Phone:352-377-1781
Practice Address - Fax:352-373-2778
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN97501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice