MEDICARE: DR SCOTT R VINSON DMD A PROFESSIONAL DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	44274	CA

General Provider Information

NPI Number	:	1245439694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SCOTT R VINSON DMD A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1204 COTTONWOOD ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-4362
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 COTTONWOOD ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-4362
Country	:	US
Telephone Number	:	530-662-3994
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SCOTT RICHARD VINSON
Credential	:	DMD
Telephone Number	:	530-662-3994

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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