Healthcare Provider Details

I. General information

NPI: 1144324278
Provider Name (Legal Business Name): STEPHEN KIRK VINCENT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 BOB BILLINGS PKWY SUITE A
LAWRENCE KS
66049-3851
US

IV. Provider business mailing address

4811 BOB BILLINGS PKWY SUITE A
LAWRENCE KS
66049-3851
US

V. Phone/Fax

Practice location:
  • Phone: 785-841-2902
  • Fax: 785-841-5312
Mailing address:
  • Phone: 785-841-2902
  • Fax: 785-841-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6362
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: