Healthcare Provider Details

I. General information

NPI: 1255741872
Provider Name (Legal Business Name): DEREK VINKOVICH D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 ROYALTON RD
NORTH ROYALTON OH
44133-4927
US

IV. Provider business mailing address

1492 HAMPTON KNOLL DR
AKRON OH
44313-4839
US

V. Phone/Fax

Practice location:
  • Phone: 440-237-3223
  • Fax:
Mailing address:
  • Phone: 440-391-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-024282
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: