Provider Demographics
NPI:1699190025
Name:VAN GEMERT, MARK JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:VAN GEMERT
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 1:2001 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3957
Mailing Address - Country:US
Mailing Address - Phone:509-534-4600
Mailing Address - Fax:509-533-6334
Practice Address - Street 1:2001 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3957
Practice Address - Country:US
Practice Address - Phone:509-534-4600
Practice Address - Fax:509-533-6334
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29672122300000X
WADE 60616536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist