1043285067 NPI number — DR. THOMAS SCOTT VINCE DMD

Table of content: DR. THOMAS SCOTT VINCE DMD (NPI 1043285067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043285067 NPI number — DR. THOMAS SCOTT VINCE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VINCE
Provider First Name:
THOMAS
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043285067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 TOWNE SQUARE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-5729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-836-2375
Provider Business Mailing Address Fax Number:
724-836-1424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
985 TOWNE SQUARE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-5729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-2375
Provider Business Practice Location Address Fax Number:
724-836-1424
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DSO27537L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DS027537L . This is a "STATE DENTAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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