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General NPI Number Information
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NPI Number | 1609249044
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Entity Type | Organization
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Legal Business Name | JOHN VININGS, DDS, P.A.
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 2811 S LOOP 289 STE 12
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City | LUBBOCK
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State | TX
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Zip | 79423-1443
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Country | US
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Telephone | 806-748-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 S LOOP 289 STE 12
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City | LUBBOCK
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State | TX
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Zip | 79423-1443
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Country | US
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Telephone | 806-748-9797
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Fax |
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Authorized Official
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Title or Position | DDS/PRACTICE OWNER
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Name | JOHN VININGS
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Credential |
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Telephone | 806-748-9797
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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 | 19235
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License Number State | TX
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