Provider Demographics
NPI:1700096377
Name:VAN ZYL, IAN P (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:P
Last Name:VAN ZYL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1124
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461-1124
Mailing Address - Country:US
Mailing Address - Phone:707-987-2773
Mailing Address - Fax:707-987-0688
Practice Address - Street 1:21038 CALISTOGA ST.
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CA
Practice Address - Zip Code:95461-1124
Practice Address - Country:US
Practice Address - Phone:707-987-2773
Practice Address - Fax:707-987-0688
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics