Individual
DR. GARRY VANGENDEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
17 W 4TH ST, LA JUNTA, CO 81050-3636
(719) 383-2083
Mailing address
330 THE VILLAGE DRIVE, APT 112, REDONDO BEACH, CA 90277
(201) 214-3838
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DDS108583
CA
1223G0001X
General Practice Dentistry
DEN.00202413
CO
Other
Enumeration date
01/09/2015
Last updated
04/03/2023
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