Gaige Ryan Vandezande, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019033650 Issued in IL

Practice address

804 S 3Rd St
St Charles, IL 60174-4053

Phone

(630) 377-1200

Fax

(630) 377-9801

NPI assigned

Jun 2, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1578202040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2142 PRENTISS DR APT 112",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605162214",
            "telephone_number": "704-245-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 S 3RD ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601744053",
            "telephone_number": "630-377-1200",
            "fax_number": "630-377-9801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 N 4th St",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601342125",
            "country_code": "US",
            "telephone_number": "630-232-4076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDEZANDE",
        "first_name": "GAIGE",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-02",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019033650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Van Boekel, BCBA
• Hayley Van Duyn, OTR/L
• Robert John Van Tholen, D.C.
• Natalie Vandenbos
• Paul Edwin Vander Sande, L. C. P. C.
• Ashley Vanopstall, PSYD
• Vivian S Vanroekel, M.D.
• Margaret Cathleen Varga, DC
• Krupa R Varghese
• Amy Vaughan, MS,OTR/L

• Dentist in St Charles, IL
• Providers in St Charles, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.