Provider Demographics
NPI:1003803651
Name:DO, VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 TREMEZZO DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3560
Mailing Address - Country:US
Mailing Address - Phone:714-995-2614
Mailing Address - Fax:
Practice Address - Street 1:324 E ANAHEIM ST
Practice Address - Street 2:STE C
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3291
Practice Address - Country:US
Practice Address - Phone:562-435-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice