Provider Demographics
NPI:1174614226
Name:VONK, KYLE LON (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LON
Last Name:VONK
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 1:2607 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3001
Mailing Address - Country:US
Mailing Address - Phone:269-428-4430
Mailing Address - Fax:269-428-0037
Practice Address - Street 1:2607 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3001
Practice Address - Country:US
Practice Address - Phone:269-428-4430
Practice Address - Fax:269-428-0037
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016338122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist