Healthcare Provider Details

I. General information

NPI: 1275840035
Provider Name (Legal Business Name): TERRY L. VINCENT, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HIDDEN VALLEY RD
ROYAL OAKS CA
95076-9271
US

IV. Provider business mailing address

136 HIDDEN VALLEY RD
ROYAL OAKS CA
95076-9271
US

V. Phone/Fax

Practice location:
  • Phone: 831-596-6395
  • Fax:
Mailing address:
  • Phone: 831-596-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number22558
License Number StateCA

VIII. Authorized Official

Name: DR. TERRY LEE VINCENT
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 831-596-6395