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General NPI Number Information
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NPI Number | 1700274271
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Entity Type | Organization
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Legal Business Name | BRIAN J. VINEYARD, D.D.S., P.C.
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 333 MAPLE ST
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City | SUTHERLAND
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State | NE
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Zip | 69165-3000
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Country | US
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Telephone | 308-386-2236
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Fax | 308-386-4545
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Provider Business Mailing Address
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Address Line | PO BOX 797
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City | SUTHERLAND
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State | NE
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Zip | 69165-0797
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Country | US
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Telephone | 308-386-2236
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Fax | 308-386-4545
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN J VINEYARD
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Credential | DDS
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Telephone | 308-386-2236
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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 | 4783
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License Number State | NE
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