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General NPI Number Information
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NPI Number | 1073708343
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Entity Type | Individual
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Provider Name | VINCENT IP DDS
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Gender | Male
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 4245 S GRAND CANYON DR 108
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City | LAS VEGAS
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State | NV
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Zip | 89147-7161
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Country | US
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Telephone | 702-579-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 9750 PEACE WAY #2061
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City | LAS VEGAS
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State | NV
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Zip | 89147-8233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5062
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22901
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53391
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License Number State | NY
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