Provider Demographics
NPI:1619079357
Name:VAN ROEKEL, NED BYRON (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:NED
Middle Name:BYRON
Last Name:VAN ROEKEL
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2906
Mailing Address - Country:US
Mailing Address - Phone:831-372-9391
Mailing Address - Fax:831-372-9066
Practice Address - Street 1:275 EL DORADO ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2906
Practice Address - Country:US
Practice Address - Phone:831-372-9391
Practice Address - Fax:831-372-9066
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516981223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics