=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043223852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES F VINCEK DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2844 SUMMIT ST SUITE 206
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-452-1704
-----------------------------------------------------
Fax | 541-268-9414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2844 SUMMIT ST SUITE 206
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-452-1704
-----------------------------------------------------
Fax | 541-268-9414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER RECEPTIONIST
-----------------------------------------------------
Name | MRS. JANET LORAINE PELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-452-1704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 21216
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------