MEDICARE: DR. RONNIE MCVAE VINSON SR. D.D.S.

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	2670	LA

General Provider Information

NPI Number	:	1699929620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONNIE MCVAE VINSON SR. D.D.S.

Provider Business Mailing Address
First Line	:	2136 MIRABEAU AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3920
Country	:	US
Telephone Number	:	504-282-3354
Fax Number	:	504-283-7200

Provider Business Practice Location Address
First Line	:	2136 MIRABEAU AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3920
Country	:	US
Telephone Number	:	504-282-3354
Fax Number	:	504-283-7200

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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