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General NPI Number Information
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NPI Number | 1508272915
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Entity Type | Individual
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Provider Name | TODD STEVEN VINCENT DDS
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Gender | Male
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 2114 S HIGHLAND DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-2807
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Country | US
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Telephone | 801-467-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 1765 N TOWN EAST BLVD STE 111
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City | MESQUITE
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State | TX
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Zip | 75150-4151
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Country | US
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Telephone | 972-270-7210
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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 | 00202233
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33749
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9236046-9922
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License Number State | UT
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