MEDICARE: JEFFREY VINCENT DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	D.007214-C1	AL

General Provider Information

NPI Number	:	1528758273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY VINCENT DMD

Provider Business Mailing Address
First Line	:	1919 7TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-2005
Country	:	US
Telephone Number	:	205-934-3387
Fax Number	:

Provider Business Practice Location Address
First Line	:	5751 POCAHONTAS RD
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-5476
Country	:	US
Telephone Number	:	205-477-4242
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	06/29/2023

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Directions to “ JEFFREY VINCENT DMD” Practice Location

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