Provider Demographics
NPI:1669486171
Name:VAN GEMERT, JOHN ANDREW (DDS PS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:VAN GEMERT
Suffix:
Gender:M
Credentials:DDS PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 SOUTH PERRY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-534-2232
Mailing Address - Fax:509-532-8636
Practice Address - Street 1:1118 SOUTH PERRY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-534-2232
Practice Address - Fax:509-532-8636
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049622Medicaid
WA000010154539OtherBCBS