Provider Demographics
NPI:1770037285
Name:JOHN ANDREW VAN GEMERT DDS PS
Entity Type:Organization
Organization Name:JOHN ANDREW VAN GEMERT DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:VAN GEMERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-534-2232
Mailing Address - Street 1:1118 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3525
Mailing Address - Country:US
Mailing Address - Phone:509-534-2232
Mailing Address - Fax:509-532-8636
Practice Address - Street 1:1118 S PERRY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3525
Practice Address - Country:US
Practice Address - Phone:509-534-2232
Practice Address - Fax:509-532-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty