Healthcare Provider Details

I. General information

NPI: 1558657460
Provider Name (Legal Business Name): SHYLER D. VINCENT, DDS , PROFESSIONAL DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 WATERFORD BLVD SUITE #445
OKLAHOMA CITY OK
73118-1122
US

IV. Provider business mailing address

6305 WATERFORD BLVD SUITE #445
OKLAHOMA CITY OK
73118-1122
US

V. Phone/Fax

Practice location:
  • Phone: 405-843-5885
  • Fax: 405-842-6988
Mailing address:
  • Phone: 405-843-5885
  • Fax: 405-842-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHYLER D. VINCENT
Title or Position: DENTIST
Credential: DDS
Phone: 405-206-8913