Individual
DR. JOHN PETER VANSCOYOC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
908 N HERSHEY RD, SUITE2, BLOOMINGTON, IL 61704-3730
(309) 664-0570
(309) 664-6612
Mailing address
908 N HERSHEY RD, SUITE2, BLOOMINGTON, IL 61704-3730
(309) 664-0570
(309) 664-6612
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19-23614
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-23614
DENTAL LICENSE NUMBER
IL
Enumeration date
05/08/2007
Last updated
07/08/2007
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