1558657460 NPI number — SHYLER D. VINCENT, DDS , PROFESSIONAL DENTISTRY, PC

Table of content: (NPI 1558657460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558657460 NPI number — SHYLER D. VINCENT, DDS , PROFESSIONAL DENTISTRY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHYLER D. VINCENT, DDS , PROFESSIONAL DENTISTRY, PC
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:
1558657460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6305 WATERFORD BLVD
Provider Second Line Business Mailing Address:
SUITE #445
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73118-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-843-5885
Provider Business Mailing Address Fax Number:
405-842-6988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6305 WATERFORD BLVD
Provider Second Line Business Practice Location Address:
SUITE #445
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73118-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-843-5885
Provider Business Practice Location Address Fax Number:
405-842-6988
Provider Enumeration Date:
06/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
SHYLER
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
405-206-8913

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1376771196 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com