Healthcare Provider Details

I. General information

NPI: 1134611932
Provider Name (Legal Business Name): GEORGE WILLIAM VINCEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 E SUNSHINE ST STE Q
SPRINGFIELD MO
65804-2143
US

IV. Provider business mailing address

3259 E SUNSHINE ST STE Q
SPRINGFIELD MO
65804-2143
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-3220
  • Fax:
Mailing address:
  • Phone: 417-881-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2018018443
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: