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General NPI Number Information
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NPI Number | 1629753249
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Entity Type | Individual
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Provider Name | JONATHAN VINCENT
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Gender | Male
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 780 E ROMIE LN STE B
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City | SALINAS
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State | CA
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Zip | 93901-4223
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Country | US
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Telephone | 831-424-2986
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Fax |
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Provider Business Mailing Address
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Address Line | 136 HIDDEN VALLEY RD
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City | ROYAL OAKS
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State | CA
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Zip | 95076-9271
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Country | US
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Telephone | 831-595-1744
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 109630
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License Number State | CA
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