Provider Demographics
NPI:1093907461
Name:VINCENT D. DINICK, DMD, MD, PC
Entity Type:Organization
Organization Name:VINCENT D. DINICK, DMD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DINICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:248-919-1100
Mailing Address - Street 1:200 ARNET ST
Mailing Address - Street 2:STE. 180
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5753
Mailing Address - Country:US
Mailing Address - Phone:248-919-1100
Mailing Address - Fax:
Practice Address - Street 1:200 ARNET ST
Practice Address - Street 2:STE. 180
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5753
Practice Address - Country:US
Practice Address - Phone:248-444-5496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010769632086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P13990Medicare PIN
MI=========OtherTAX ID
MI0P13990Medicare PIN
MI4361557 10Medicaid