MEDICARE: VINCENT T. VAN D.M.D.

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	1223G0001X	General Practice Dentistry	D 8293	OR
2	1223P0221X	Pediatric Dentistry	DN19534	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942296942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT T. VAN D.M.D.

Provider Business Mailing Address
First Line	:	8749 THE ESPLANADE APT 27
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-7736
Country	:	US
Telephone Number	:	503-750-9718
Fax Number	:

Provider Business Practice Location Address
First Line	:	5316 CENTRAL FLORIDA PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-8772
Country	:	US
Telephone Number	:	407-239-9557
Fax Number	:

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

Provider Enumeration Date	:	09/25/2005
Last Update Date	:	04/24/2013

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