Provider Demographics
NPI:1073651113
Name:VINCENT, KAREN ANNE (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANNE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-7607
Mailing Address - Country:US
Mailing Address - Phone:408-395-0402
Mailing Address - Fax:408-395-3294
Practice Address - Street 1:711 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7607
Practice Address - Country:US
Practice Address - Phone:408-395-0402
Practice Address - Fax:408-395-3294
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP79124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH00079-01Medicaid