Provider Demographics
NPI:1053457770
Name:VINES, ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:VINES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:16025 HWY 72
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-0428
Mailing Address - Country:US
Mailing Address - Phone:256-247-5799
Mailing Address - Fax:256-247-5902
Practice Address - Street 1:16025 HWY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-0428
Practice Address - Country:US
Practice Address - Phone:256-247-5799
Practice Address - Fax:256-247-5902
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist