Healthcare Provider Details

I. General information

NPI: 1023000114
Provider Name (Legal Business Name): STEVEN MARK VINCENT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N MUSTANG RD
MUSTANG OK
73064-7200
US

IV. Provider business mailing address

1100 N MUSTANG RD
MUSTANG OK
73064-7200
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-2485
  • Fax: 405-376-2024
Mailing address:
  • Phone: 405-376-2485
  • Fax: 405-376-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4534
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: