1235111535 NPI number — DENNIS G VINCENT M D S C

Table of content: COURTNEY L. NALEPKA OT (NPI 1841373610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235111535 NPI number — DENNIS G VINCENT M D S C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENNIS G VINCENT M D S C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235111535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14555 W NATIONAL AVE
Provider Second Line Business Mailing Address:
STE 175
Provider Business Mailing Address City Name:
NEW BERLIN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53157-4484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-827-3144
Provider Business Mailing Address Fax Number:
262-827-3150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14555 W NATIONAL AVE
Provider Second Line Business Practice Location Address:
STE 175
Provider Business Practice Location Address City Name:
NEW BERLIN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53157-4484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-827-3144
Provider Business Practice Location Address Fax Number:
262-827-3150
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
GALEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
262-827-3144

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  29313 020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 29313 020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31409900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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