Individual
DR. JONATHAN GAY VANDERMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 887-2851
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS038172
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03251058
—
NY
05
—
1024942160001
—
PA
Enumeration date
12/16/2005
Last updated
08/19/2011
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