MEDICARE: DR. SHYLER DEE VINCENT DDS

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	6116	OK

General Provider Information

NPI Number	:	1376771196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHYLER DEE VINCENT DDS

Provider Business Mailing Address
First Line	:	509 TRINIDAD DR
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-5143
Country	:	US
Telephone Number	:	405-206-8913
Fax Number	:	405-701-1724

Provider Business Practice Location Address
First Line	:	1201 NORTH STONEWALL
Second Line	:	UNIV. OF OK COLLEGE OF DENTISTRY, AEGD
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-0901
Country	:	US
Telephone Number	:	405-271-5222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	07/01/2009

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