Individual
GARY VANDEKERCKHOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
2525 W ILES AVE, SPRINGFIELD, IL 62704-4283
(217) 787-7744
Mailing address
2525 W ILES AVE, SPRINGFIELD, IL 62704-4283
(217) 787-7744
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
A15523
IL
Other
Enumeration date
08/25/2006
Last updated
07/08/2007
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