Provider Demographics
NPI:1023000114
Name:VINCENT, STEVEN MARK (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:VINCENT
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 1:1100 N MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-7200
Mailing Address - Country:US
Mailing Address - Phone:405-376-2485
Mailing Address - Fax:405-376-2024
Practice Address - Street 1:1100 N MUSTANG RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-7200
Practice Address - Country:US
Practice Address - Phone:405-376-2485
Practice Address - Fax:405-376-2024
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist