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General NPI Number Information
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NPI Number | 1174649859
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Entity Type | Individual
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Provider Name | JOHN M VININGS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 6908 COLLEYVILLE BLVD
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City | COLLEYVILLE
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State | TX
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Zip | 76034-0547
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Country | US
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Telephone | 817-581-1177
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Fax | 817-488-0519
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Provider Business Mailing Address
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Address Line | 6908 COLLEYVILLE BLVD
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City | COLLEYVILLE
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State | TX
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Zip | 76034-0547
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Country | US
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Telephone | 817-581-1177
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Fax | 817-488-0519
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19235
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License Number State | TX
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