MEDICARE: DR. OLEG VINSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	48848	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093783730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLEG VINSON DDS

Provider Business Mailing Address
First Line	:	25 BURNS ST
Second Line	:	STE 1-C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5268
Country	:	US
Telephone Number	:	718-261-4747
Fax Number	:	718-261-4945

Provider Business Practice Location Address
First Line	:	25 BURNS ST
Second Line	:	STE 1-C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5268
Country	:	US
Telephone Number	:	718-261-4747
Fax Number	:	718-261-4945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/21/2008

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Directions to “ DR. OLEG VINSON DDS” Practice Location

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